U.S. President Donald Trump’s increasingly overt attempts to bring down the Cuban government are forcing Mexico’s President Claudia Sheinbaum into a delicate diplomatic dance. Mexico is the U.S.’s largest trading partner. It is also the primary supplier of oil to Cuba since the U.S. seized control of Venezuela’s crude. Now, Sheinbaum must manage her relationship with a mercurial Trump, who has at times both praised her leadership and threatened to send the U.S. military into her country to combat drug trafficking — all while appeasing her left-wing party Morena, factions of which have historically aligned themselves with Cuba’s communist regime. That balance became even more difficult for Sheinbaum this week following reports that Mexico’s state-run oil company, Pemex, paused a shipment of oil headed for Cuba, which is grappling with shortages following the U.S. military action earlier this month in Venezuela. Asked about the suspension, the Mexican president said only that oil shipments are a “sovereign” decision and that future action will be taken on a “humanitarian” basis. On Thursday, Trump ramped up the pressure, declared a national emergency over what he couched as threats posed by the Cuban government and authorized the use of new tariffs against any country that sells or provides oil to the island. The order gives the administration broad discretion to impose duties on imports from countries deemed to be supplying Cuba, dramatically raising the stakes for Mexico as it weighs how far it can go without triggering economic retaliation from Washington — or worse. “It’s the proverbial shit hitting the fan in terms of the spillover effects that would have,” said Arturo Sarukhán, former Mexican ambassador to the U.S., referring to the possibility of a Pemex tanker being intercepted. Sheinbaum still refuses to hit back too hard against Trump, preferring to speak publicly in diplomatic platitudes even as she faces new pressure. Her posture stands in marked contrast to Canada’s Mark Carney, whose speech at Davos, urging world leaders to stand up to Trump, went viral and drew a swift rebuke from the White House and threats of new tariffs. But the latest episode is characteristic of Sheinbaum’s approach to Trump over the last year — one that has, so far, helped her avoid the kinds of headline-grabbing public ruptures that have plagued Carney, Ukrainian President Volodymyr Zelenskyy and French President Emmanuel Macron. Still, former Mexican officials say Trump’s threats — though not specific to Mexico — have triggered quiet debate inside the Mexican government over how much risk Sheinbaum can afford to absorb and how hard she should push back. “My sense is that right now, at least because of what’s at stake in the counter-narcotics and law enforcement agenda bilaterally, I think that neither government right now wants to turn this into a casus belli,” Sarukhán added. “But I do think that in the last weeks, the U.S. pressure on Mexico has risen to such a degree where you do have a debate inside the Mexican government as to what the hell do we do with this issue?” A White House official, granted anonymity to speak candidly about the administration’s approach, said that Trump is “addressing the depredations of the communist Cuban regime by taking decisive action to hold the Cuban regime accountable for its support of hostile actors, terrorism, and regional instability that endanger American security and foreign policy.” “As the President stated, Cuba is now failing on its own volition,” the official added. “Cuba’s rulers have had a major setback with the Maduro regime that they are responsible for propping up.” Sheinbaum, meanwhile, responded to Trump’s latest executive order during her Friday press conference by warning that it could “trigger a large-scale humanitarian crisis, directly affecting hospitals, food supplies, and other basic services for the Cuban people.” “Mexico will pursue different alternatives, while clearly defending the country’s interests, to provide humanitarian assistance to the Cuban people, who are going through a difficult moment, in line with our tradition of solidarity and respect for international norms,” Sheinbaum said. The Mexican embassy in Washington declined further comment. Cuba’s Foreign Minister Bruno Rodriguez, in a post on X, accused the U.S. of “resorting to blackmail and coercion in an attempt to make other countries to join its universally condemned blockade policy against Cuba.” The pressure on Sheinbaum to respond has collided with real political constraints at home. Morena has long maintained ideological and historical ties to Cuba, and Sheinbaum faces criticism from within her coalition over any move that could be seen as abandoning Havana. At the same time, she has come under growing domestic scrutiny over why Mexico should continue supplying oil abroad as fuel prices and energy concerns persist at home, making the “humanitarian” framing both a diplomatic shield and a political necessity. Amid the controversy over the oil shipment, Trump and Sheinbaum spoke by phone Thursday morning, with Trump describing the conversation afterward as “very productive” and praising Sheinbaum as a “wonderful and highly intelligent Leader.” Sheinbaum’s remarks after the call point to how she is navigating the issue through ambiguity rather than direct confrontation, noting that the two did not discuss Cuba. She described it as a “productive and cordial conversation” and that the two leaders would “continue to make progress on trade issues and on the bilateral relationship.” With the upcoming review of the U.S.-Mexico-Canada Agreement on trade looming, even the appearance of defying Trump’s push to cut off Cuba’s oil lifelines carries the potential for economic and diplomatic blowback. It also could undo the quiet partnership the U.S. and Mexico have struck on border security and drug trafficking issues. Gerónimo Gutiérrez, who served as Mexican ambassador to the U.S. during the first Trump administration, described Sheinbaum’s approach as “squish and muddle through.” “She obviously is trying to tread carefully with Trump. She doesn’t want to irritate him with this matter,” Gutiérrez said, adding that “she knows that it’s a problem.” Meanwhile, Cuba’s vulnerability has only deepened since the collapse of Venezuela’s oil support following this month’s U.S. operation that ousted President Nicolás Maduro. For years, Venezuelan crude served as a lifeline for the island, a gap Mexico has increasingly helped fill, putting the country squarely in Washington’s crosshairs as Trump squeezes Havana. With fuel shortages in Cuba triggering rolling blackouts and deepening economic distress, former U.S. officials who served in Cuba and regional analysts warn that Trump’s push to choke off remaining oil supplies could hasten a broader collapse — even as there is little clarity about how Washington would manage the political, humanitarian or regional fallout if the island tips over the edge. Trump has openly suggested that outcome is inevitable, telling reporters in Iowa on Tuesday that “Cuba will be failing pretty soon,” even as he pushed back on Thursday that the idea he was trying to “choke off” the country. “The word ‘choke off’ is awfully tough,” Trump said. “It looks like it’s not something that’s going to be able to survive. I think Cuba will not be able to survive.” The administration, however, has offered few details about what would come next, and Latin American analysts warn that the U.S. and Mexico are likely to face an influx of migrants — including to Florida and the Yucatán Peninsula — seeking refuge should Cuba collapse. There is no evidence that the Trump administration has formally asked Mexico to halt oil shipments to Cuba. Trump’s executive order leaves it to the president’s Cabinet to determine whether a country is supplying oil to Cuba and the rate at which it should be tariffed — an unusual deferral of power for a president for whom tariffs are a favorite negotiating tool. But former U.S. officials say that absence of an explicit demand to Mexico does not mean the pressure is theoretical. Lawrence Gumbiner, who served as chargé d’affaires at the U.S. embassy in Havana during the first Trump administration, believes Washington would be far more likely to lean on economic pressure than the kind of military force it has used to seize Venezuelan oil tankers. At the same time, the administration’s push on Venezuela began with a similar executive order last spring. “There’s no doubt that the U.S. is telling Mexico to just stop it,” Gumbiner said. “I think there’s a much slimmer chance that we would engage our military to actually stop Mexican oil from coming through. That would be a last resort. But with this administration you cannot completely discount the possibility of a physical blockade of the island if they decide that it’s the final step in strangling the island.”

BRUSSELS — An identity tool that underpins the digital lives of Dutch people and has partly fallen into American hands is prompting the country to reconsider its reliance on U.S. technology. In the Netherlands, almost every citizen regularly uses the online identification tool DigiD to book a doctor’s appointment, buy a house or access online public services. With a Dutch supplier of the tool in the process of being acquired by a U.S. technology company, that’s prompting concerns that the Netherlands is giving away critical technology at a moment of heightened sensitivity around the country’s wholesale use of American services. As Dutch lawmakers in the parliament’s digital affairs committee met Tuesday to debate the issue, they received a petition signed by 140,000 people calling on the government to block the acquisition. “If the Dutch government does something that [U.S. President Donald] Trump doesn’t like, he can shut down our government with one push of a button,” the petition reads. “That’s a big danger.”  The debate over DigiD has put the spotlight on a topic that has been simmering for a while.  With the Netherlands a long-time proponent of the transatlantic relationship, Dutch society is built on U.S. technology and IT services — as is the country’s government. That’s now seen as a glaring security issue as Trump fires off threats toward Europe.  Two-thirds of the domain names of Dutch governments, schools and other critical companies rely on at least one U.S. cloud provider, research by the Dutch public broadcaster showed Sunday, with Microsoft the frontrunner.  “We are the most Microsoft-loving country of the whole world,” said Bert Hubert, a Dutch cybersecurity expert and former intelligence watchdog. “The Dutch government uses more Microsoft than the U.S. government.” OMNIPRESENT Questions over DigiD’s relationship with U.S. technology started in early November.  U.S. cloud provider Kyndryl, a recent spin-off of the well-known U.S. tech company IBM, announced at the time that it would acquire Dutch cloud provider Solvinity. That company doesn’t own the online identification tool DigiD but provides the platform on which it runs.  To Dutch people, DigiD is ubiquitous in their lives. “Every time you want to rent a house in the Netherlands, make an appointment with the doctor or do something in the hospital, you have to go through DigiD,” Hubert said.  Potential U.S. control over such an omnipresent tool triggered fierce pushback.  Last year the International Criminal Court, based in The Hague, ditched Microsoft as a service provider amid concerns about U.S. sanctions targeting the court. | Erik S. Lesser/EPA Putting vital digital infrastructure in American hands “raises Dutch vulnerability for outages, manipulation or even blackmail,” a group of experts, among them Hubert, said in a letter their lawyers sent mid-January to the ministry service in charge of scrutinising acquisitions.   The acquisition could also endanger the security of Dutch people’s sensitive personal data, lawmakers and experts argue. “The risk is that it falls under the U.S. Cloud Act, which says that it doesn’t matter if data is hosted on EU soil, but if the service is done by a U.S. company, then the [U.S.] government can ask for that data,” said Barbara Kathmann, lawmaker of the GreenLeft-Labour party and expert in digital affairs.  The Dutch Economy Ministry is now looking into the deal and whether it raises national security concerns, a ministry representative said in the Dutch parliament last week. Kyndryl said in a statement that it “always lived up to relevant Dutch and European requirements for the security of customers’ data and will continue to comply with existing obligations of Solvinity to its customers.” CAUTIONARY TALE The Solvinity acquisition has put the spotlight on a topic that has been simmering for a while.  Last year the International Criminal Court, based in The Hague, ditched Microsoft as a service provider amid concerns about U.S. sanctions targeting the court.  The ICC case and the Solvinity acquisition should serve as a cautionary tale for Europe to start mapping its reliance on the U.S. and nurturing European alternatives, said Sarah El Boujdaini, a lawmaker for the centrist D66 — the party of the incoming prime minister Rob Jetten. “We need to have a wider look at where our most vulnerable dependencies are, where we need to take back control, and where we need to procure more from European companies,” said El Boujdaini.  That should include a particular focus on government services and services that people access continually, several interviewees said. “Traditional government services should not be outsourced to other countries, especially not countries that are willing and have shown to be capable of weaponizing those dependencies,” said Dutch liberal European Parliament lawmaker Bart Groothuis.  “Of course [the government] should make use of the services of ICT providers,” said Hubert, “but what you should not do is give a part of your society that you depend on 24 hours a day to a company that can be acquired.”

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

MARSEILLE, France — Violence at a drug trafficking hotspot in the social housing complex next to Orange’s headquarters in Marseille forced the telecoms giant to lock its forest-green gates and order its thousands of employees to work from home. The disruption to such a recognizable company — one that gives its name to the city’s iconic football venue — became a fresh symbol of how drug trafficking and insecurity are reshaping politics ahead of municipal elections. In a recent poll, security ranked among voters’ top concerns, forcing candidates across the spectrum to pitch competing responses to the drug trade. “The number one theme is security,” center-right candidate Martine Vassal told POLITICO. “In the field, what I hear most often are people who tell me that they no longer travel in the heart of the city for that reason.” French political parties are watching the contest closely for clues about the broader battles building toward the 2027 presidential race. In many ways, Marseille is a microcosm of France as a whole, reflecting the country’s wider demographics and its biggest political battles. The city is diverse. Multicultural and low-income neighborhoods that tend to support the hard left abut conservative suburbs that have swung to the far right in recent years. As in much of France, support for the political center in Marseille is wobbling.  The left-wing incumbent Benoît Payan remains a slight favorite in the March contest, but Franck Allisio, the candidate for the far-right National Rally, is just behind, with both men polling at around 30 percent. The issues at play strike at the heart of Marseille’s identity: its notorious drug trade, entrenched poverty and failure to seize on the competitive advantages of a young, sun-drenched city strategically perched on the Mediterranean. Whichever candidate can articulate a platform that speaks to Marseille’s local realities while addressing anxieties shared across France will be well positioned to take city hall — and to provide their party with a potential blueprint for the 2027 presidential campaign.  SECOND CITY  Marseille has always had something of a little-brother complex with Paris, a resentment that goes beyond the football rivalry of Paris Saint-Germain and Olympique de Marseille. Many in the city regard the French capital as a distant power center that tries to impose its own solutions on Marseille without sufficiently consulting local experts.   People in Marseilles pay tribute to murdered Mehdi Kessaci. 20, whose brother is a prominent anti drug trafficking campaigner, and protest against trafficking, Nov. 22, 2025. | Clement Mahoudeau/AFP via Getty Images “Paris treats Marseille almost like a colony,” said Allisio. “A place you visit, make promises to — without any guarantee the money will ever be spent.”  When it comes to drug trafficking and security, leaders across the political spectrum agree that Paris is prescribing medicine that treats the symptoms of the crisis, not the cause.  Violence associated with the drug trade was thrust back in the spotlight in November with the killing of 20-year-old Mehdi Kessaci. Authorities are investigating the crime as an act of intimidation. Mehdi’s brother Amine Kessaci is one of the city’s most prominent anti-trafficking campaigners, rising to prominence after their half-brother — who was involved in the trade — was killed several years earlier.  President Emmanuel Macron, Interior Minister Laurent Nuñez and Justice Minister Gérald Darmanin all visited Marseille in the wake of Kessaci’s killing, outlining a tough-on-crime agenda to stop the violence and flow of drugs.  Locals stress that law-and-order investments must be matched with funding for public services. Unless authorities improve the sluggish economy that has encouraged jobless youths to turn to the drug trade, the problem will continue.  “Repression alone is not efficient,” said Kaouther Ben Mohamed, a former social worker turned activist. “If that was the case, the drug trade wouldn’t have flourished like it did.” Housing is another issue, with many impoverished residents living in dangerous, dilapidated buildings. “We live in a shit city,” said Mahboubi Tir, a tall, broad-shouldered young man with a rugby player’s physique. “We’re not safe here.”   Tir spent a month in a coma and several more in a hospital last April after he was assaulted during a parking dispute. His face was still swollen and distorted when he spoke to POLITICO in December about how the incident reshaped his relationship with the city he grew up in.  “I almost died, and I was angry at the city,” said Tir, who suffers from memory loss and has only a vague recollection of what led to the assault, as he sipped coffee in the backroom office of a tiny, left-leaning grassroots political party where he volunteers, Citizen Ambition.  SECURITY PROBLEM To what extent Marseille’s activist groups can bring about change in a city whose struggles have lasted for decades remains to be seen, but the four leading candidates for mayor share a similar diagnosis. They all believe the lurid crime stories making national headlines are a byproduct of a lack of jobs and neglected public services — and that the French state’s responses miss the mark. Rather than relying on harsher punishments as a deterrent, they argue the state should prioritize local policing and public investment. When Payan announced his candidacy for reelection, he pledged free meals for 15,000 students to get them back in school and to double the number of local cops as part of a push for more community policing. Allisio’s platform puts the emphasis on security-related spending: increased video surveillance, more vehicles for local police and the creation of “specialized units to combat burglary and public disorder.” Vassal — the center-right backed by the conservative Les Républicains and parties aligned with Macron — has similarly put forward a proposal to arm fare enforcers in public transport. Both Allisio and Vassal are calling for unspecified spending cuts while preserving basic services provided at the local level like schools, public transportation and parks and recreation. Vassal, who is polling third, said she would make public transportation free for residents younger 26 to travel across the spread-out city. She accuses the current administration of having delivered an insufficient number of building permits, slowing the development of new housing and office buildings and thus the revitalization of Marseille’s most embattled areas — a trend she pledged to reverse. Both Vassal and Allisio are advocating for less local taxes on property to boost small businesses and create new jobs. Allisio has also put forward a proposal to make parking for less 30 minutes free to facilitate deliveries and quick stops to buy products. The outlier — at least when it comes to public safety — is Sébastien Delogu, a disciple of three-time hard-left presidential candidate Jean-Luc Mélenchon. Though Delogu is polling fourth at 14 percent, he can’t be counted out, given that Mélenchon won Marseille in the first round of the last two presidential elections. Though Delogu acknowledges that crime is a problem, he doesn’t want to spend more money on policing. He instead proposes putting money that other candidates want to spend on security toward poverty reduction, housing supply and the local public health sector. Whoever wins, however, will have to grapple with an uncomfortable truth. Aside from local police responsible for public tranquility and health, policing and criminal justice matters are largely managed at the national level. The solution to Marseille’s problems will depend, to no small extent, on the outcome of what happens next year in Paris.

LONDON — Keir Starmer’s government has a crunch decision to make: Whether to keep heating much of the British state via a firm linked to Russian fossil fuels. Under an existing public sector deal, TotalEnergies Gas & Power — a U.K. subsidiary of French energy giant TotalEnergies — supplies the gas used to heat No. 10 Downing Street, the Treasury, and other parts of Whitehall.  That agreement, worth up to £8 billion, expires early next year. Officials are preparing a public tendering process for its replacement, which will be awarded later this year and will run from 2027 to 2030.  But TotalEnergies retains ties to fossil fuel trade with Vladimir Putin’s Russia. Now, pro-Ukrainian campaigners and parliamentarians — including the Labour chair of the all-party parliamentary group (APPG) on Ukraine — want ministers to rule out its subsidiary from winning the new contract.  In a letter to Cabinet Office Minister Nick Thomas-Symonds, who oversees government procurement body the Crown Commercial Service, they warn that “continuing a contract with companies involved with Russia’s energy sector is inconsistent” with the U.K.’s repeatedly-touted goal of undermining Russia’s fossil fuel revenues, which are used to finance its war on Ukraine.    “In view of escalating Russian hybrid attacks against the U.K., and ongoing brutal attacks across Ukraine, public sector procurement must align not only with sanctions but also with government foreign policy, including efforts to deter and disrupt Russian aggression,” they write.  The letter — co-ordinated by campaign groups Razom We Stand and B4 Ukraine —  is co-signed by Labour MP Alex Sobel, who chairs the Ukraine APPG, as well as Green MPs Carla Denyer and Siân Berry, both former party co-leaders. Sobel, who has visited Ukraine seven times since the full-scale invasion, last month called for “maximum pressure on Russia.” OUT IN THE COLD Svitlana Romanko, executive director of Razom We Stand, said that “brutal Russian attacks on our energy systems” had knocked out “energy and heating systems across Ukraine in -20C weather.”  “We implore the U.K. government to end their contract with TotalEnergies,” she said.  Under the existing gas deal, public buildings in Whitehall, and other public sector buildings around the U.K. including NHS hospitals, are supplied with gas for heating and cooking by TotalEnergies Gas & Power.   While the contract itself complies with the U.K.’s ban on Russian gas imports, it has been condemned by Ukrainian campaign groups and Labour MPs because of TotalEnergies’ continued ties to Russian fossil fuels.    The firm holds a 20 percent stake in the Yamal liquefied natural gas facility in Siberia, from where it continues to import Russian gas to Europe under long-term contracts which it says it cannot break.  A TotalEnergies spokesperson said the firm “condemned Russia’s military aggression against Ukraine.” The firm “operates legally within the framework of the energy policy and sanctions policy defined by the authorities of the European Union and its member states,” they added.  TotalEnergies has been the gas supplier of choice for the U.K. public sector since 2019, under the two successive CCS procurement contracts.   The new contract — known as Supply of Energy 3 — is now being prepared. A tender notice is expected to be published in June and a contract awarded in December.  A Cabinet Office spokesperson declined to comment on a live procurement process.

LONDON — Nigel Farage has a new recruit to his Reform UK cause. They haven’t always been the best of pals. Robert Jenrick, a former Tory leadership contender, defected to Farage’s right-wing cause Thursday after being fired from the Conservatives by party Leader Kemi Badenoch. Farage is “obviously the right person to lead the movement for change Britain needs,” Jenrick said, adding the Reform leader was “all too often a lone voice of common sense.” Farage and Jenrick haven’t always been on the friendliest of terms. After the duo’s Thursday night love-in at a London press conference, POLITICO sweeps through the seven occasions the pair were at each other’s throats. SEPTEMBER 2024: FARAGE SAYS JENRICK BELIEVES IN NOTHING Farage showed little love for Jenrick when he offered himself as a future Conservative Party leader in the 2024 contest to replace Rishi Sunak. Jenrick was “formerly a man that believed in nothing” who pitched himself as the “great hardliner,” Farage said in a post on X as the contest reached its climax. “This is almost certainly done for political gain and not out of conviction. He will divide the party,” Farage added. Making sure he had really hammered home his distaste, Farage concluded: “I doubt that Jenrick will last long if he wins.” OCTOBER 2024: FARAGE BRANDS JENRICK A HYPOCRITE Farage never misses an opportunity to bash a former Conservative minister over their record in government. Jenrick wasn’t spared in his past life. Pictured Jan. 15, 2026 … but these two have history. | Jordan Pettitt/PA Images via Getty Images The Reform leader couldn’t resist a Jenrick jab when POLITICO reported that long-term contracts for housing irregular migrants had actually been approved by Jenrick while he was immigration minister. Farage decried Jenrick as a “hypocrite” for attack Labour on similar grounds, adding: “Don’t believe a word that he says on anything.” Their first pint as Reform pals could be awkward. APRIL 2025: FARAGE VERSUS ROBERT GENERIC Asked by Sky whether Jenrick would be welcome in Reform, Farage’s answer was equivocal: “Maybe … if we thought he was genuine, yes.” But it came with this caveat. “Don’t forget…this is Robert Generic. This is Robert the Remainer. This is the Robert the ‘I don’t stand particularly for anything at all’ who suddenly appears to be … on this Damascene conversion.” MAY 2025: JENRICK SAYS FARAGE HAS HAD TOO MANY PINTS It cuts both ways. Jenrick has been happy to throw the odd insult Farage’s way too. Lambasting Reform’s social security policy, the ex-Tory got personal: “Has he cooked this up after one too many pints at his local?,” Jenrick asked. “Has a joint found its way into his usual pack of Marlboro Golds?” AUGUST 2025: JENRICK CLAIMS HE’S GOT FARAGE RATTLED Farage and Jenrick traded blows last summer amid heated protests over a hotel housing irregular migrants in Essex. Farage labeled Jenrick “no friend” of the English town of Epping after the then shadow justice secretary visited a rally outside the Bell Hotel. “When Robert Jenrick was immigration minister he grew the number of illegal migrants living in free hotels to 56,000,” tweeted Farage with a one minute video to boot. Eager to grab the last word, Jenrick responded: “You’re rattled.” By Jenrick’s account Thursday, he started talking to Farage about a possible defection just weeks later. AUGUST 2025: FARAGE CALLS JENRICK A FRAUD Farage found more of Jenrick’s ministerial record to bash last summer. “Jenrick is a fraud,” he tweeted to his millions of followers. “I’ve always thought so, this quote proves it.” The quote in question? Jenrick speaking in 2022 about procuring more hotels for migrants who cross the English Channel. SEPTEMBER 2025: DON’T LET FARAGE RUN A SCHOOL, SAYS JENRICK Jenrick told the Sun Farage was “a good bloke to go to the pub with and he speaks to a lot of people in the country.” “But I don’t think Nigel’s the kind of bloke you want to have running your kids’ schools, or running your local hospital,” adding he wasn’t sure “if Nigel actually thinks he is the right person to do that himself.” And earlier that year, Jenrick said it was his ambition to “put Reform out of business,” and send Farage back “to retirement.” That hasn’t quite happened. If you can’t beat them, join them, eh?

LONDON — Reza Pahlavi was in the United States as a student in 1979 when his father, the last shah of Iran, was toppled in a revolution. He has not set foot inside Iran since, though his monarchist supporters have never stopped believing that one day their “crown prince” will return.  As anti-regime demonstrations fill the streets of more than 100 towns and cities across the country of 90 million people, despite an internet blackout and an increasingly brutal crackdown, that day may just be nearing.   Pahlavi’s name is on the lips of many protesters, who chant that they want the “shah” back. Even his critics — and there are plenty who oppose a return of the monarchy — now concede that Pahlavi may prove to be the only figure with the profile required to oversee a transition.  The global implications of the end of the Islamic Republic and its replacement with a pro-Western democratic government would be profound, touching everything from the Gaza crisis to the wars in Ukraine and Yemen, to the oil market.  Over the course of three interviews in the past 12 months in London, Paris and online, Pahlavi told POLITICO how Iran’s Supreme Leader Ayatollah Ali Khamenei could be overthrown. He set out the steps needed to end half a century of religious dictatorship and outlined his own proposal to lead a transition to secular democracy. Nothing is guaranteed, and even Pahlavi’s team cannot be sure that this current wave of protests will take down the regime, never mind bring him to power. But if it does, the following is an account of Pahlavi’s roadmap for revolution and his blueprint for a democratic future.  POPULAR UPRISING  Pahlavi argues that change needs to be driven from inside Iran, and in his interview with POLITICO last February he made it clear he wanted foreign powers to focus on supporting Iranians to move against their rulers rather than intervening militarily from the outside.  “People are already on the streets with no help. The economic situation is to a point where our currency devaluation, salaries can’t be paid, people can’t even afford a kilo of potatoes, never mind meat,” he said. “We need more and more sustained protests.” Over the past two weeks, the spiraling cost of living and economic mismanagement have indeed helped fuel the protest wave. The biggest rallies in years have filled the streets, despite attempts by the authorities to intimidate opponents through violence and by cutting off communications. Pahlavi has sought to encourage foreign financial support for workers who will disrupt the state by going on strike. He also called for more Starlink internet terminals to be shipped into Iran, in defiance of a ban, to make it harder for the regime to stop dissidents from communicating and coordinating their opposition. Amid the latest internet shutdowns, Starlink has provided the opposition movements with a vital lifeline. As the protests gathered pace last week, Pahlavi stepped up his own stream of social media posts and videos, which gain many millions of views, encouraging people onto the streets. He started by calling for demonstrations to begin at 8 p.m. local time, then urged protesters to start earlier and occupy city centers for longer. His supporters say these appeals are helping steer the protest movement. Reza Pahlavi argues that change needs to be driven from inside Iran. | Salvatore Di Nolfi/EPA The security forces have brutally crushed many of these gatherings. The Norway-based Iranian Human Rights group puts the number of dead at 648, while estimating that more than 10,000 people have been arrested. It’s almost impossible to know how widely Pahlavi’s message is permeating nationwide, but footage inside Iran suggests the exiled prince’s words are gaining some traction with demonstrators, with increasing images of the pre-revolutionary Lion and Sun flag appearing at protests, and crowds chanting “javid shah” — the eternal shah. DEFECTORS Understandably, given his family history, Pahlavi has made a study of revolutions and draws on the collapse of the Soviet Union to understand how the Islamic Republic can be overthrown. In Romania and Czechoslovakia, he said, what was required to end Communism was ultimately “maximum defections” among people inside the ruling elites, military and security services who did not want to “go down with the sinking ship.”  “I don’t think there will ever be a successful civil disobedience movement without the tacit collaboration or non-intervention of the military,” he said during an interview last February.  There are multiple layers to Iran’s machinery of repression, including the hated Basij militia, but the most powerful and feared part of its security apparatus is the Islamic Revolutionary Guard Corps. Pahlavi argued that top IRGC commanders who are “lining their pockets” — and would remain loyal to Khamenei — did not represent the bulk of the organization’s operatives, many of whom “can’t pay rent and have to take a second job at the end of their shift.”  “They’re ultimately at some point contemplating their children are in the streets protesting … and resisting the regime. And it’s their children they’re called on to shoot. How long is that tenable?” Pahlavi’s offer to those defecting is that they will be granted an amnesty once the regime has fallen. He argues that most of the people currently working in the government and military will need to remain in their roles to provide stability once Khamenei has been thrown out, in order to avoid hollowing out the administration and creating a vacuum — as happened after the 2003 U.S.-led invasion of Iraq.  Only the hardline officials at the top of the regime in Tehran should expect to face punishment.  In June, Pahlavi announced he and his team were setting up a secure portal for defectors to register their support for overthrowing the regime, offering an amnesty to those who sign up and help support a popular uprising. By July, he told POLITICO, 50,000 apparent regime defectors had used the system.  His team are now wary of making claims regarding the total number of defectors, beyond saying “tens of thousands” have registered. These have to be verified, and any regime trolls or spies rooted out. But Pahlavi’s allies say a large number of new defectors made contact via the portal as the protests gathered pace in recent days.  REGIME CHANGE In his conversations with POLITICO last year, Pahlavi insisted he didn’t want the United States or Israel to get involved directly and drive out the supreme leader and his lieutenants. He always said the regime would be destroyed by a combination of fracturing from within and pressure from popular unrest.  He’s also been critical of the reluctance of European governments to challenge the regime and of their preference to continue diplomatic efforts, which he has described as appeasement. European powers, especially France, Germany and the U.K., have historically had a significant role in managing the West’s relations with Iran, notably in designing the 2015 nuclear deal that sought to limit Tehran’s uranium enrichment program.  But Pahlavi’s allies want more support and vocal condemnation from Europe. U.S. President Donald Trump pulled out of the nuclear deal in his first term and wasted little time on diplomacy in his second. He ordered American military strikes on Iran’s nuclear facilities last year, as part of Israel’s 12-day war, action that many analysts and Pahlavi’s team agree leaves the clerical elite and its vast security apparatus weaker than ever.  U.S. President Donald Trump pulled out of the nuclear deal in his first term and wasted little time on diplomacy in his second. | Pool photo by Bonnie Cash via EPA Pahlavi remains in close contact with members of the Trump administration, as well as other governments including in Germany, France and the U.K. He has met U.S. Secretary of State Marco Rubio several times and said he regards him as “the most astute and understanding” holder of that office when it comes to Iran since the 1979 revolution.  In recent days Trump has escalated his threats to intervene, including potentially through more military action if Iran’s rulers continue their crackdown and kill large numbers of protesters.  On the weekend Pahlavi urged Trump to follow through. “Mr President,” he posted on X Sunday. “Your words of solidarity have given Iranians the strength to fight for freedom,” he said. “Help them liberate themselves and Make Iran Great Again!” THE CARETAKER KING  In June Pahlavi announced he was ready to replace Khamenei’s administration to lead the transition from authoritarianism to democracy.   “Once the regime collapses, we have to have a transitional government as quickly as possible,” he told POLITICO last year. He proposed that a constitutional conference should be held among Iranian representatives to devise a new settlement, to be ratified by the people in a referendum.  The day after that referendum is held, he told POLITICO in February, “that’s the end of my mission in life.”  Asked if he wanted to see a monarchy restored, he said in June: “Democratic options should be on the table. I’m not going to be the one to decide that. My role however is to make sure that no voice is left behind. That all opinions should have the chance to argue their case — it doesn’t matter if they are republicans or monarchists, it doesn’t matter if they’re on the left of center or the right.”  One option he hasn’t apparently excluded might be to restore a permanent monarchy, with a democratically elected government serving in his name.  Pahlavi says he has three clear principles for establishing a new democracy: protecting Iran’s territorial integrity; a secular democratic system that separates religion from the government; and “every principle of human rights incorporated into our laws.” He confirmed to POLITICO that this would include equality and protection against discrimination for all citizens, regardless of their sexual or religious orientation.  COME-BACK CAPITALISM  Over the past year, Pahlavi has been touring Western capitals meeting politicians as well as senior business figures and investors from the world of banking and finance. Iran is a major OPEC oil producer and has the second biggest reserves of natural gas in the world, “which could supply Europe for a long time to come,” he said.  “Iran is the most untapped reserve for foreign investment,” Pahlavi said in February. “If Silicon Valley was to commit for a $100 billion investment, you could imagine what sort of impact that could have. The sky is the limit.”  What he wants to bring about, he says, is a “democratic culture” — even more than any specific laws that stipulate forms of democratic government. He pointed to Iran’s past under the Pahlavi monarchy, saying his grandfather remains a respected figure as a modernizer.  “If it becomes an issue of the family, my grandfather today is the most revered political figure in the architect of modern Iran,” he said in February. “Every chant of the streets of ‘god bless his soul.’ These are the actual slogans people chant on the street as they enter or exit a soccer stadium. Why? Because the intent was patriotic, helping Iran come out of the dark ages. There was no aspect of secular modern institutions from a postal system to a modern army to education which was in the hands of the clerics.”   Pahlavi’s father, the shah, brought in an era of industrialization and economic improvement alongside greater freedom for women, he said. “This is where the Gen Z of Iran is,” he said. “Regardless of whether I play a direct role or not, Iranians are coming out of the tunnel.”  Conversely, many Iranians still associate his father’s regime with out-of-touch elites and the notorious Savak secret police, whose brutality helped fuel the 1979 revolution. NOT SO FAST  Nobody can be sure what happens next in Iran. It may still come down to Trump and perhaps Israel.  Anti-regime demonstrations fill the streets of more than 100 towns and cities across the country of 90 million people. | Neil Hall/EPA Plenty of experts don’t believe the regime is finished, though it is clearly weakened. Even if the protests do result in change, many say it seems more likely that the regime will use a mixture of fear tactics and adaptation to protect itself rather than collapse or be toppled completely.  While reports suggest young people have led the protests and appear to have grown in confidence, recent days have seen a more ferocious regime response, with accounts of hospitals being overwhelmed with shooting victims. The demonstrations could still be snuffed out by a regime with a capacity for violence.  The Iranian opposition remains hugely fragmented, with many leading activists in prison. The substantial diaspora has struggled to find a unity of voice, though Pahlavi tried last year to bring more people on board with his own movement.  Sanam Vakil, an Iran specialist at the Chatham House think tank in London, said Iran should do better than reviving a “failed” monarchy. She added she was unsure how wide Pahlavi’s support really was inside the country. Independent, reliable polling is hard to find and memories of the darker side of the shah’s era run deep. But the exiled prince’s advantage now may be that there is no better option to oversee the collapse of the clerics and map out what comes next. “Pahlavi has name recognition and there is no other clear individual to turn to,” Vakil said. “People are willing to listen to his comments calling on them to go out in the streets.”

KYIV — The Russian army attacked Ukraine with more than 90 killer drones in the early hours of Thursday morning, causing complete blackouts in the key industrial regions of Dnipro and Zaporizhzhia, Kyiv’s energy ministry reported. “While energy workers managed to restore power in the Zaporizhzhia region in the morning, some 800,000 households in the nearby Dnipro region were still without electricity and heating on Thursday morning,” Artem Nekrasov, acting energy minister of Ukraine, said during a morning briefing. In Dnipro, eight coal mines stopped working because of a power outage. All the miners were safely evacuated to the surface, Nekrasov added. Power outages were also reported in Chernihiv, Kyiv, Ivano-Frankivsk, Poltava and other regions. Freezing weather is coming to Ukraine over the next three days, with temperatures forecast to drop to minus 20° C during the night, when Russia often launches massive missile and drone attacks. Precipitation and cold could cause additional electricity supply disruptions due to snow accumulating on power lines, Ukrainian Prime Minister Yulia Svyrydenko said Wednesday evening. “Ukraine’s energy system is under enemy attack every day, and energy workers work in extremely difficult conditions to provide people with light and heat. Deteriorating weather conditions create additional stress on critical infrastructure. We are working to minimize the consequences of bad weather,” Svyrydenko added. Local governors in the eastern regions of Zaporizhzhia and Dnipro reported that hospitals and other critical infrastructure had to turn to emergency power supplies because of the latest Russian attack. President Volodymyr Zelenskyy thanked Ukrainian energy workers for the speedy power restoration in Zaporizhzhia, and used the opportunity to remind Kyiv’s partners around the world they need to respond “to this deliberate torment of the Ukrainian people by Russia.” “There is absolutely no military rationale in such strikes on the energy sector and infrastructure that leave people without electricity and heating in wintertime. This is Russia’s war specifically against our people, against life in Ukraine — an attempt to break Ukraine,” Zelenskyy added.

President Donald Trump has told his health secretary, Robert F. Kennedy Jr., to consider aligning the U.S. vaccination schedule with those in Europe, where many countries recommend fewer vaccines. Kennedy has taken up the charge with gusto and is considering advising parents to follow Denmark’s childhood schedule rather than America’s. Many who specialize in vaccination and public health say that would be a mistake. While wealthy European countries do health care comparatively well, they say, there are lots of reasons Americans are recommended more shots than Europeans, ranging from different levels of access to health care to different levels of disease. “If [Kennedy] would like to get us universal health care, then maybe we can have a conversation about having the schedule adjusted,” Demetre Daskalakis, who led the Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases before resigning in protest in August, told POLITICO. Children, especially those who live in poor and rural areas, would be at greater risk for severe disease and death if the U.S. were to drop shots from its schedule, Daskalakis said. Denmark, for instance, advises immunizing against only 10 of the 18 diseases American children were historically recommended immunizations against. It excludes shots for potentially serious infections, including hepatitis A and B, meningitis and respiratory syncytial virus. Under Kennedy, the government has already changed its hepatitis B vaccine recommendations for newborns this year, even as critics warned the new advice could lead to more chronic infections, liver problems and cancer. The health department points out that the new guidance on hepatitis B — that mothers who test negative for the virus may skip giving their newborn a shot in the hospital — now align more closely with most countries in Europe. Public health experts and others critical of the move say slimmer European vaccine schedules are a cost-saving measure and a privilege afforded to healthier societies, not a tactic to protect kids from vaccine injuries. Kennedy’s interest in modeling the U.S. vaccine schedule after Europe, they point out, is underpinned by his belief that some childhood vaccines are unsafe and that American kids get too many too young. Kennedy’s safety concerns don’t align with the rationale underpinning the approach in Europe, where the consensus is that childhood vaccines are safe. Wealthy European countries in many cases eschew vaccines based on a risk-benefit calculus that doesn’t hold in America. European kids often don’t get certain shots because it would prevent a very small number of cases — like hepatitis B — or because the disease is rarely serious for them, such as Covid-19 and chickenpox. But since the U.S. doesn’t have universal access to care, vaccinating provides more return on investment, experts say. “We just have a tradition to wait a little bit” before adding vaccines to government programs, said Johanna Rubin, a pediatrician and vaccine expert for Sweden’s health agency. Swedish children are advised to get vaccines for 11 diseases before they turn 18. Rubin cited the need to verify the shots’ efficacy and the high cost of new vaccines as reasons Sweden moves slowly to add to its schedule. “It has to go through the health economical model,” she said. VACCINE SAFETY’S NOT THE ISSUE Martin Kulldorff, a Swedish native and former Harvard Medical School professor who led Kennedy’s vaccine advisory panel until this month, pointed to that country’s approach to vaccination and public health in an interview with POLITICO earlier this year. Before the Centers for Disease Control and Prevention this month dropped its recommendation that children of mothers who test negative for hepatitis B receive a vaccine within a day of birth, Kulldorff cited Sweden’s policy. “In Sweden, the recommendation is that you only do that if the mother has the infection. That’s the case in most European countries,” he said. “You could have a discussion whether one or the other is more reasonable.” The U.S. policy, as of Dec. 16, more closely resembles Sweden’s, with hepatitis B-negative mothers no longer urged to vaccinate their newborns against the virus at birth. But Sweden’s public health agency recommends that all infants be vaccinated, and the country’s regional governments subsidize those doses, which are administered as combination shots targeting six diseases starting at 3 months. Public health experts warn that even children of hepatitis B-negative mothers could catch the virus from others via contact with caregivers who are positive or shared household items. The prevalence of chronic hepatitis B in the U.S. is 6.1 percent compared to 0.3 percent in Sweden, according to the Coalition for Global Hepatitis Elimination, a Georgia-based nonprofit which receives funding from pharmaceutical companies, the CDC and the National Institutes of Health, among others. Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said the U.S. has taken a more comprehensive approach to vaccination, in part because its population is sicker than that of some Western European countries, and the impact of contracting a disease could be more detrimental. Osterholm pointed to the Covid pandemic as an example. By May 2022, the U.S. had seen more than 1 million people die. Other high-income countries — though much smaller — had more success controlling mortality, he said. “People tried to attribute [the disparity] to social, political issues, but no, it was because [peer nations] had so many more people who were actually in low-risk categories for serious illness,” Osterholm said. Kennedy and his advisers also cited European views on Covid vaccination in the spring when the CDC dropped its universal recommendation, instead advising individuals to talk to their providers about whether to get the shot. Last month, the Food and Drug Administration’s top vaccine regulator, Vinay Prasad, linked the deaths of 10 children to Covid vaccination without providing more detailed information about the data behind his assertion. European countries years ago stopped recommending repeat Covid vaccination for children and other groups not considered at risk of becoming severely sick. Covid shots have been linked to rare heart conditions, primarily among young men. European vaccine experts say Covid boosters were not recommended routinely for healthy children in many countries — not because of safety concerns, but because it’s more cost-effective to give them to high-risk groups, such as elderly people or those with health conditions that Covid could make severely sick and put in the hospital. In the U.K., Covid-related hospitalizations and deaths declined significantly after the pandemic, and now are “mostly in the most frail in the population, which has led to more restricted use of the vaccines following the cost-effectiveness principles,” said Andrew Pollard, the director of the Oxford Vaccine Group in the United Kingdom, which works on developing vaccines and was behind AstraZeneca’s Covid-19 shot. Pollard led the Joint Committee on Vaccination and Immunization, which advises the U.K. government, for 12 years before stepping down in September. In the U.S., more moves to follow Europe are likely. At a meeting of Kennedy’s vaccine advisers earlier this month, Tracy Beth Høeg, now acting as the FDA’s top drug regulator, pointed to Denmark’s pediatric schedule, which vaccinates for 10 diseases, while questioning whether healthy American children should be subject to more vaccines than their Danish counterparts. Danish kids typically don’t get shots for chickenpox, the flu, hepatitis A and B, meningitis, respiratory syncytial virus and rotavirus, like American children do, though parents can privately pay for at least some of those vaccines. The country offers free Covid and flu vaccines to high-risk kids. After the vaccine advisory meeting wrapped, Trump said he was on board, directing Kennedy to “fast track” a review of the U.S. vaccine schedule and potentially align it with other developed nations. He cited Denmark, Germany and Japan as countries that recommend fewer shots. Last week, Kennedy came within hours of publicly promoting Denmark’s childhood vaccine schedule as an option for American parents. The announcement was canceled at the last minute after the HHS Office of the General Counsel said it would invite a lawsuit the administration could lose, a senior department official told POLITICO. The notion that the U.S. would drop its vaccine schedule in favor of a European one struck health experts there as odd. Each country’s schedule is based on “the local situation, so the local epidemiology, structure of health care services, available resources, and inevitably, there’s a little bit of political aspect to it as well,” said Erika Duffell, a principal expert on communicable disease prevention and control at the European Centre for Disease Prevention and Control, an EU agency that monitors vaccine schedules across 30 European countries. Vaccine safety isn’t the issue, she said. For example, even though most Europeans don’t get a hepatitis B shot within 24 hours of birth, the previous U.S. recommendation, “there is a consensus that the effectiveness and safety of the vaccine has been confirmed through decades of research” and continuous monitoring, she said. European nations like Denmark and the U.K. have kept new cases of hepatitis B low. Denmark recorded no cases of mother-to-child transmission in 2023, and Britain’s rate of such spread is less than 0.1 percent — though the latter does routinely recommend vaccinating low-risk infants beginning at 2 months of age. European experts point to high levels of testing of pregnant women for hepatitis B and most women having access to prenatal care as the reasons for success in keeping cases low while not vaccinating all newborns. The major differences between the U.S. and the U.K. in their approach to hepatitis B vaccination are lower infection rates and high screening uptake in Britain, plus “a national health system which is able to identify and deliver vaccines to almost all affected pregnancies selectively,” Pollard said. The CDC, when explaining the change in the universal birth dose recommendation, argued the U.S. has the ability to identify nearly all hepatitis B infections during pregnancy because of ”high reliability of prenatal hepatitis B screening,” which some European experts doubt. “If we change a program, we need to prepare the public, we need to prepare the parents and the health care providers, and say where the evidence comes from,” said Pierre Van Damme, the director of the Centre for the Evaluation of Vaccination at the University of Antwerp in Belgium. He suggested that, if there was convincing evidence, U.S. health authorities could have run a pilot study before changing the recommendation to evaluate screening and the availability of testing at birth in one U.S. state, for example. WHERE EUROPEANS HAVE MORE DISEASE In some cases, European vaccination policies have, despite universal health care, led to more disease. France, Germany and Italy moved from recommending to requiring measles vaccination over the last decade after outbreaks on the continent. The U.S., until recently, had all but eradicated measles through a universal recommendation and school requirements. That’s starting to change. The U.S. is at risk of losing its “measles-elimination” status due to around 2,000 cases this year that originated in a Texas religious community where vaccine uptake is low. The 30 countries in the European Union and the European Economic Area, which have a population of some 450 million people combined, reported more than 35,000 measles cases last year, concentrated in Romania, Austria, Belgium and Ireland. Europe’s comparatively high rate is linked to lower vaccination coverage than the level needed to prevent outbreaks: Only four of the 30 countries reached the 95-percent threshold for the second measles dose in 2024, according to the European Centre for Disease Prevention and Control. Kennedy touted the U.S.’s lower measles rate as a successful effort at containing the sometimes-deadly disease, but experts say the country could soon see a resurgence of infectious diseases due to the vaccine skepticism that grew during the pandemic and that they say Kennedy has fomented. Among kindergarteners, measles vaccine coverage is down 2.7 percentage points as of the 2024-2025 school year, from a peak of 95.2 percent prior to the pandemic, according to CDC data. That drop occurred before Kennedy became health secretary. Kennedy and his advisers blame it on distrust engendered by Covid vaccine mandates imposed by states and President Joe Biden. But Kennedy led an anti-vaccine movement for years before joining the Trump administration, linking shots to autism and other conditions despite scientific evidence to the contrary, and he has continued to question vaccine safety as secretary. In some EU nations, vaccines aren’t compulsory for school entry. Swedish law guarantees the right to education and promotes close consultation between providers and patients. Some governments fear mandates could push away vaccine-hesitant parents who want to talk the recommended shots over with their doctor before giving the vaccines to their children, Rubin explained. In the U.S., states, which have the authority to implement vaccine mandates for school entry, rely on the CDC’s guidance to decide which to require. Vaccine skeptics have pushed the agency to relax some of its recommendations with an eye toward making it easier for American parents to opt out of routine shots. Scandinavian nations maintain high vaccine uptake without mandates thanks to “high trust” in public health systems, Rubin said. In Sweden, she added, nurses typically vaccinate young children at local clinics and provide care for them until they reach school age, which helps build trust among parents. CHICKENPOX Another example of where the U.S. and Europe differ is the chickenpox vaccine. The U.S. was the first country to begin universal vaccination against the common childhood illness in 1995; meanwhile, 13 EU nations broadly recommend the shot. Denmark doesn’t officially track chickenpox — the vaccine isn’t included on its schedule — but estimates 60,000 cases annually in its population of 6 million. The vastly larger U.S. sees fewer than 150,000 cases per year, according to the CDC. Many European countries perceive chickenpox as a benign disease, Van Damme said. “If you have a limited budget for prevention, you will spend usually the money in other preventative interventions, other vaccines than varicella,” he said, referring to the scientific term for chickenpox. But there’s another risk if countries decide to recommend chickenpox vaccination, he explained. If the vaccination level is low, people remain susceptible to the disease, which poses serious risks to unborn babies. If it’s contracted in early pregnancy, chickenpox could trigger congenital varicella syndrome, a rare disorder that causes birth defects. If children aren’t vaccinated against chickenpox, almost all would get the disease by age 10, Van Damme explained. If countries opt for vaccination, they have to ensure robust uptake: vaccinate virtually all children by 10, or risk having big pockets of unvaccinated kids who could contract higher-risk infections later. Europe’s stance toward chickenpox could change soon. Several countries are calculating that widely offering chickenpox vaccines would provide both public health and economic benefits. Britain is adding the shot to its childhood schedule next month. Sweden is expected to green-light it as part of its national program in the coming months. While the public doesn’t see it as a serious disease, pediatricians who see serious cases of chickenpox are advocating for the vaccine, Rubin told POLITICO. “It is very contagious,” she said. “It fulfills all our criteria.” The U.K. change comes after its vaccine advisory committee reviewed new data on disease burden and cost-effectiveness — including a 2022 CDC study of the U.S. program’s first 25 years that also examined the vaccine’s impact on shingles, a painful rash that can occur when the chickenpox virus reactivates years later. Scientists had theorized for years that limiting the virus’ circulation among children could increase the incidence of shingles in older adults by eliminating the “booster” effect of natural exposure, but the U.S. study found that real-world evidence didn’t support that hypothesis.

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.