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.

LONDON — In February Britain’s cash-strapped Labour government cut international development spending — and barely anyone made a noise. The center-left party announced it would slice the country’s spending on aid down to only 0.3 percent of gross domestic income — from 0.5 percent — in order to fund a hike in defense spending. MPs, aid experts and officials have told POLITICO that the scale of the cuts is on a par with — or even exceeding — those of both the previous center-right Conservative government or the United States under Donald Trump. This leaves Britain’s development arm, once globally envied as a vehicle for poverty alleviation, a shadow of its former self. The move — prompted by U.S. demands to up its NATO spending, and mirroring the Trump administration’s move to gut its own USAID development budget — shocked Labour’s progressive MPs, supporters and backers in the aid sector. But unlike attempted cuts to British welfare spending, the real-world backlash was muted, with the resignation of Britain’s development minister prompting little further dissent or change in policy. There was no mutiny in parliament, and only limited domestic and international condemnation outside of an aid sector torn between making their voices heard — and keeping in Whitehall’s good books over slices of the shrinking pie. Some fear a return grab over the aid budget could still be on the cards — but that the government will find that there is little left to cut. Gideon Rabinowitz, director of policy and advocacy at Bond, the U.K. network for NGOs, warned that, instead of “reversing the cuts by the previous Conservative government, Labour has compounded them, and lives will be lost as a result.” “These cuts will further tarnish the U.K.’s reputation as it continues to be known as an unreliable global partner, breaking Labour’s manifesto commitment,” he warned. “The Conservatives started the fire, but instead of putting it out, this Labour government threw petrol on it.” ‘IT WAS THE PERFECT TIME TO DO IT’ When Prime Minister Keir Starmer announced the cut to international aid — a bid to save over £6 billion by 2027 — Labour MPs, including those who worked in the sector before being elected, were notably silent. The move followed a 2021 Conservative cut to aid spending — from 0.7 percent in the Tory brand-rebuilding David Cameron years down to 0.5 percent. At the time, Labour MPs had met that Tory cut with howls of outrage. This time it was different. Some were genuinely shocked, while others feared retribution from a Downing Street that had flexed its muscles at MPs who rebelled on what they saw as points of conscience. “No one was expecting it, so there was no opportunity to campaign around it,” said one Labour MP. “Literally none of us had any idea it was coming.” Remaining spending is largely mandatory contributions to organizations such as the World Bank. | Daniel Slim/AFP via Getty Images The same MP noted that there are around 50 Labour MPs from the new 2024 intake who had some form of development background before coming into parliament. Yet they were put “completely under the cosh” by Downing Street and government whips. “It was the perfect time to do it,” the MP said. A number of MPs who might have been vocal have since been made parliamentary private secretaries — the most junior government role. “They have basically gagged the people who would be most likely to be outspoken on it,” the MP above said. The department’s ministerial team is now more likely to be loyal to the Starmer project. “I just felt hurt, and wounded. We were stunned. None of us saw it coming,” said one MP from the 2024 cohort, adding: “They priced in that backlash wouldn’t come.” But they added: “If we were culpable so were NGOs, too inward-looking and focused on peripheral issues.” The lack of outcry from MPs would, however, seem to put them largely in step with the wider British public. Polling and focus groups from think tank More in Common suggest that despite the majority of voters thinking spending on international aid is the right thing to do in a variety of circumstances, only around 20 percent of the public think the budget was cut too much.  The second new-intake Labour MP quoted above said the policy was therefore an “easy thing to sell on the doorstep,” and “in my area, there’s not going to be shouting from the rooftops to spend more money on aid.” DIMINISHED AND DEMORALIZED The cuts to aid come at a time when Britain’s Foreign Office is undergoing a radical overhaul. While the department describes its plans as “more agile,” staff, programs and entire areas of focus are all ripe for cuts to save money. The department is looking to make redundancies for around 25 percent of staff based in the U.K. MPs have voiced concern that development staff will be among the first to make the jump due to the government’s shift away from aid. The department insists that no final decisions have been taken over the size and shape of the organization. Major cuts are expected across work on education, conflict, and WASH (Water, Sanitation, and Hygiene.) The government’s Integrated Security Fund — which funds key counter-terror programs abroad — is also looking to scale back work abroad which does not have a clear link to Britain’s national security. The British Council — a key soft-power organization viewed as helping combat Chinese and Russian reach across the world — told MPs it is in “real financial peril” and would be cutting its presence in 35 of the 97 countries it operates. The BBC’s World Service is seeing similar cuts to its global reach. The Independent Commission for Aid Impact (ICAI), the watchdog for aid spending, is also not safe from the ax as the government continues its bonfire of regulators. The FCDO did not refute the expected pathway of cuts. Published breakdowns of spending allocations for the next three years are due to be published in the coming months, an official said. A review of Britain’s development and diplomacy policies conducted by economist Minouche Shafik — who has since been moved into Downing Street — sits discarded in the department. The government refuses to publish its findings. Aid spending was spared a repeat visit by Chancellor Rachel Reeves in her government-wide budget last month — but that hasn’t stopped MPs worrying about a second bite. | Pool Photo by Adrian Dennis via Getty Images The second 2024 intake MP quoted earlier in the piece said that following the U.S. decisions on aid and foreign policy “there was an expectation that the U.K., as a responsible international partner, as a leader on a lot of this stuff, would fill the gap to some extent, and then take more of a leadership role on it, and we’ve done the opposite.” NOTHING LEFT TO CUT Aid spending was spared a repeat visit by Chancellor Rachel Reeves in her government-wide budget last month — but that hasn’t stopped MPs worrying about a second bite. While few MPs or those in the aid sector feel Britain will ever return to the lofty heights of its 0.7 percent commitment, they predict there will be harder resistance if the government comes back for more. “I don’t think they’re going to try and do it again, as there’s no money left,” the second 2024 intake MP said. But they pointed out that a large portion of the remaining aid budget is spent on in-country costs such as accommodation for asylum seekers. Savings identified from the asylum budget would be sent back to the Treasury, rather than put back into the aid budget, they noted. Remaining spending is largely mandatory contributions to organizations such as the World Bank or the United Nations and would, they warned, involve “getting rid of international agreements and chopping up longstanding influence at big international institutions that we are one of the leading people in.” The United Nations is already facing its own funding crisis as it struggles to adjust to the global downturn in aid spending. British diplomat Tom Fletcher — who leads the UN’s humanitarian response — said earlier this year that the organization has been “forced into a triage of human survival,” adding: “The math is cruel, and the consequences are heartbreaking.” The government still has a commitment to returning to 0.7 percent of GNI “as soon as the fiscal circumstances allow.” The tests for this ramp back up were set out four years ago. Britain must not be borrowing for day-to-day spending and underlying debt must be falling. The last two budgets have forecast that the government will not meet these tests in this parliament. FARAGE CIRCLES In the meantime, Labour’s opponents feel emboldened to go further. Both the Conservatives and Reform UK have said that they would further cut the aid budget. The Tories have vowed to slice it down to 0.1 percent of GNI, while Nigel Farage’s Reform UK is eyeing fresh cuts of at least by £7-8 billion a year. A third 2024 Labour MP said that there was a degree of pressure among some colleagues to match the Conservatives’ 0.1 percent pledge. Though no country has gone as far as Uganda’s Idi Amin in setting up a “save Britain fund” for its “former colonial masters,” Britain’s departure on international aid gives space for other countries wanting to step up to further their own foreign policy aims. The space vacated by Britain and America has prompted warnings that China will step in, while countries newer to international development such as Gulf states could try and fill the void. Many of these nations are unlikely to ever fund the same projects as the U.K. and the U.S., forcing NGOs to look to alternate donors such as philanthropists to fund their work. “There’ll be a big, big gap, and it won’t be completely filled,” the second new intake MP said. An FCDO spokesperson said the department was undergoing “an unprecedented transformation,” and added: “We remain resolutely committed to international development and have been clear we must modernize our approach to development to reflect the changing global context. We will bring U.K. expertise and investment to where it is needed most, including global health solutions and humanitarian support.”

BRUSSELS — When the colonial governments of Belgium and Portugal ordered the construction of a railway connecting oil- and mineral-rich regions in the African interior to the Atlantic, their primary objective was to plunder resources such as rubber, ivory and minerals for export to Western countries.  Today, that same stretch of railway infrastructure, snaking through Zambia, the Democratic Republic of Congo and Angola to the port of Lobito, is being modernized and extended with U.S. and EU money to facilitate the transport of sought-after minerals like cobalt and copper. Just this month, Jozef Síkela, the EU commissioner for international partnerships, signed a €116 million investment package for the corridor, often hailed as a model initiative under Global Gateway, the bloc’s infrastructure development program. This time around, however, Brussels says it’s committed to resetting its historically tainted relationship with the region — a message European Commission President Ursula von der Leyen and European Council President António Costa will stress when they address African and EU leaders at a Nov. 24-25 summit in Luanda, Angola, which is this year celebrating 50 years of independence from Portuguese rule.  “Global Gateway is about mutual benefits,” von der Leyen said in a keynote speech in October. The program should “focus even more on key value chains,” including the metals and minerals needed in everything from smartphones to wind turbines and defense applications.  The aim, she said, is to “build up resilient value chains together. With local infrastructure, but also local jobs, local skills and local industries.”  Yet Brussels is scrambling to enter a region only to find that China got there first. Batches of copper sheets are stored in a warehouse and wait to be loaded on trucks in Zambia. | Per-Anders Pettersson/Getty Images African countries are already the primary suppliers of minerals to Beijing, which has secured access to their resource wealth — unhindered by any historical baggage of colonial exploitation — and is now the world’s dominant processor. Europe’s emphasis on retaining economic value in host countries — rather than merely extracting resources for export — answers calls by African leaders for a more equitable and sustainable approach to developing their countries’ natural resources.  “The EU has been quite vocal, since the beginning of the raw minerals diplomacy two years ago, saying: We want to be the ethical partner,” said Martina Matarazzo, international and EU advocacy coordinator at Resource Matters, a Belgian NGO focusing on resource extraction, which also has an office in Kinshasa, DRC.  But “there is a big gap” between what’s being said and what’s being done, she added, pointing out that it is still unclear how the Lobito Corridor can be a “win-win” project, rather than just facilitating the shipping of minerals abroad.  Brussels finds itself under growing pressure to diversify its supply chains of lithium, rare earths and other raw materials away from China — which has demonstrated time and again it is ready to weaponize its market dominance. To that end, it is drafting a new plan, due on Dec. 3, to accelerate the bloc’s diversification efforts.   In African countries, however, Brussels is still struggling to establish itself as an attractive, ethical alternative to Beijing, which has long secured vast access to the continent’s resources through large-scale investments in mining, processing and infrastructure.  To enter the minerals space, the EU needs to walk the talk in close cooperation with African leaders — doing so may be its only chance to secure resources while moving away from its extractivist past, POLITICO has found in conversations with researchers, policymakers and civil society.  RESOURCE RUSH Appetite for Africa’s vast natural riches first drew colonizers to the continent — and laid “the foundation for post-independence resource dependency and external interference,” according to the Africa Policy Research Institute. Now, the continent’s deposits of vital minerals have turned it into a strategic player, with Zambian President Hakainde Hichilema last year setting a goal of tripling copper output by the end of the decade, for instance. Beijing has often used Belt and Road, its international development initiative, to secure mining rights in exchange for infrastructure projects. Washington, which lags far behind Beijing, is also stepping up its game, with investments into Africa quietly overtaking China’s. President Donald Trump has extended the U.S. security umbrella to war-torn areas in exchange for access to resources, for example brokering a — shaky — peace deal between Rwanda and the DRC. EU companies are “really trying to catch up,” said Christian Géraud Neema Byamungu, an expert on China-Africa relations and the Francophone Africa editor of the China Global South Project. “They left Africa when there was a sense that Africa is not really a place to do business.” DOING THINGS DIFFERENTLY Against this backdrop, the key question for the EU is: What can it offer to set itself apart from other partners? On paper, the answer is clear: a responsible approach to resource extraction that prioritizes creating local economic value, along with high environmental and social standards.  “We want to focus on the sustainable development of value chains and how to work with our African partners to support their rise of the value chains,” said an EU official ahead of the Luanda summit, where minerals will be a key topic. “This is not about extraction only,” they added. But so far, that still has to translate into a concrete impact on the ground. “We are not at the point where we can see how really the EU is trying to change things on the ground in terms of value addition in DRC,” said Emmanuel Umpula Nkumba, executive director of NGO Afrewatch. “I am not naïve, they are coming to make money, not to help us,” he added.  Not only has offtake from the Lobito Corridor been slow, but the project has also come under fire for prioritizing Western interests over African development and agency, and for potentially leading to the destruction of local forests, community displacement and an overall lack of benefits for local populations.  The 2024 Lobito Corridor Trans-Africa Summit | Andrew Caballero-Reynolds/AFP via Getty Images The EU, however, views the corridor as “a symbol of the partnership between the African and European continent and an example of our shared investment agenda,” according to a Commission spokesperson, who called it “a lifeline towards sustainable development and shared prosperity.” Finally, while “value addition” has become a catchphrase, it’s unclear whether EU and African leaders see eye to eye on what the term means.  African industry representatives and officials often point to building a domestic supply chain up to the final product. EU officials, by contrast, tend to envision refining minerals in the country of origin and then exporting them, according to a report published by the European Council on Foreign Relations. A SUSTAINABLE BUSINESS CASE? The second component of the EU’s approach — strong sustainability and human rights safeguards — faces major trouble, not least in the name of making the EU more competitive.  In Brussels, proposed rules that would require companies to police their supply chains for environmental harm and human rights violations are dying a slow death, as conservative politicians channel complaints from businesses that they can’t bear the cost of complying. An investigation by the Business & Human Rights Resource Centre of the 13 mining, refining and recycling projects outside the bloc labeled “strategic” by the EU executive — including four in Africa — identified “an inconsistent approach to key human rights policies.”  However, under pressure from African leaders, stricter safeguards are slowly becoming more important in the sector: “high [environmental, social and governance] standards” are a core component of the African Union’s mining strategy published in 2024.  The Chinese, too, are adapting quickly.  “China’s also getting good with standards,” said Sarah Logan, a visiting fellow at the European Council on Foreign Relations who co-authored the assessment of African and European interpretations of value addition. “If they are made to, Chinese mining companies are very capable of adhering to ESG standards.”  Therefore, besides massively scaling up investment, the EU and European companies will need to turn their promise of being a reliable and ethical partner into reality — sooner rather than later. “The only way to distinguish ourselves from the Chinese is to guarantee these benefits for communities,” Spanish Green European lawmaker Ana Miranda Paz told a panel discussion on the Lobito Corridor in Brussels. This story has been updated with comment from the European Commission.

President Donald Trump has pardoned a long list of prominent allies who backed his effort to subvert the 2020 election, according to Justice Department Pardon Attorney Ed Martin, who posted the relevant document Sunday night. Among those who received the “full, complete and unconditional” pardons were Rudy Giuliani, who helped lead an effort to pressure state legislatures to reject Joe Biden’s victories in key swing states; Mark Meadows, Trump’s chief of staff in 2020 and a crucial go-between for Trump and state officials; John Eastman and Kenneth Chesebro, two attorneys who helped devise a strategy to pressure then-Vice President Mike Pence to overturn the election on Jan. 6, 2021; Boris Epshteyn, a longtime Trump adviser; and Sidney Powell, a conservative attorney who launched a fringe legal assault on election results in key swing states. The pardons are largely symbolic — none of those identified were charged with federal crimes. The document posted by Martin is also undated, so it’s unclear when Trump signed it. The White House and Justice Department did not immediately respond to requests for comment. Giuliani, Eastman and Powell were among those identified by former special counsel Jack Smith as Trump’s co-conspirators, though he never brought charges against them. The pardons would preclude any future administration from potentially pursuing a criminal case against them. The language of the pardon is broad, applying to “all United States citizens for conduct relating to the advice, creation, organization, execution, submission, support, voting activities, participation in or advocacy for or of any slate or proposed slate of presidential electors … as well for any conduct relating to their efforts to expose voting fraud and vulnerabilities in the 2020 presidential election.” Though Trump has long insisted he has the power to pardon himself for federal crimes — an untested proposition — it appears he is not yet prepared to test that theory. Though the pardon document indicates it could apply to others who fit the same criteria, it explicitly excludes Trump. In addition to his inner circle, Trump pardoned dozens of GOP activists who signed paperwork falsely claiming to be legitimate presidential electors, a key component of the bid to pressure Pence. Dozens of people on Trump’s list were charged in states that also investigated Trump’s bid to subvert the election that year, including in Georgia, Arizona, Wisconsin and Nevada. But presidents don’t have the power to pardon state crimes. The pardons are the latest attempt by Trump to rewrite the history of his bid to seize a second term he didn’t win in 2020, an effort that culminated in the violent attack on the Capitol by a mob of his supporters who attempted to halt the transfer of power. Trump pardoned more than 1,000 of those who joined the mob within hours of his inauguration in January, including hundreds who assaulted police officers protecting the Capitol. Among those pardoned are a group of former state GOP chairs, including Georgia’s David Shafer, Arizona’s Kelli Ward and Nevada’s Michael McDonald, all of whom were charged by their states’ attorneys general for their roles in the elector scheme. The pardons included James Troupos, a Wisconsin attorney who is facing similar charges in his state for his role overseeing the elector effort. The pardons also include Jenna Ellis, a Trump campaign attorney who worked closely with Giuliani but later pleaded guilty to charges in Georgia and cooperated with prosecutors in multiple states. Chesebro, too, pleaded guilty to a felony charge in Georgia and cooperated with prosecutors in Arizona and Nevada.

ROME — The conservative think tank behind Donald Trump’s Project 2025 roadmap is looking for new friends across the Atlantic.  The Heritage Foundation, the intellectual engine behind the 922-page blueprint that has become the key policy manual for Trump’s second term, is partnering with a constellation of European nationalist far-right movements to export its playbook for countering progressive policies.  That included a conference in late October at the frescoed former home of late premier Silvio Berlusconi in Rome focused on Europe’s demographic crisis and the idea that falling birthrates pose a threat to Western civilization. Speakers included Roger Severino, Heritage’s vice president of domestic policy and the architect of the group’s campaign to roll back abortion access in the U.S., as well as Italy’s pro-life family minister Eugenia Roccella, the deputy speaker of the Senate, and members of Italian right-wing think tanks.  Severino and the Heritage Foundation’s president, Kevin Roberts, have also been speaking guests at summits and assemblies of far-right groups such as Patriots for Europe, which includes Marine Le Pen’s Rassemblement National and Italy’s League, under a Make Europe Great Again banner.  Meanwhile Heritage representatives have held private meetings in Washington and Brussels with lawmakers from far-right parties in Hungary, Czechia, Spain, France and Germany. Just in the past 12 months, the group held seven meetings with members of the European Parliament, compared to just one in the five years prior, according to Parliament records. And they’ve had additional meetings with MEPs that weren’t formally reported, including with three members from Italian Prime Minister Giorgia Meloni’s Brothers of Italy party. Severino told POLITICO that meetings with the European right serve to exchange ideas. But the meetings signal more than pleasantries. For European politicians, they’re a way to get access to people in Trump’s orbit. For Heritage, they’re a way to extend influence beyond Washington and achieve its ideological goals, which under Roberts have grown increasingly aligned with Trump’s MAGA approach.  Mike Gonzalez, a senior fellow at Heritage, said he meets with conservative parties to share experience in dealing with common challenges — “comparing notes, that kind of thing.” He said his interlocutors are “very interested” in policies on abortion, gender theory, defense and China, adding that parts of Project 2025 such as a section he wrote on defunding public broadcasters, are “very transferable” to Europe.  The foundation has been active in Europe for years, he points out, but demand has increased since Trump’s return to office. European right-wing leaders, Gonzalez said, “see Trump and what he is doing and say, ‘I want to get me some of that.’”  BETTER THE SECOND TIME It’s not the first time MAGA has attempted to galvanize the European right. Trump’s former strategist Steve Bannon unsuccessfully tried to unite populist nationalist parties under the Movement think tank in 2019, hamstrung by a lack of buy-in from the parties themselves.  Some observers are doubtful this renewed push will go differently. “I’m skeptical that it will amount to much,” said EJ Fagan, an associate politics professor at the University of Illinois and author of The Thinkers, a book on partisan think tanks. “The European right have their own resources that produce policies, so there’s not a lot Heritage can provide to European parties.”  That is especially an issue, Fagan noted, when it comes to finessing legislation, since Heritage doesn’t have a deep bench of “people who have a fine understanding of laws and treaties” in Europe.  But the Heritage Foundation’s European mission comes as far-right groups gain ground across Europe by tapping public frustration over issues such as immigration, climate policy and sovereignty and pushing policies that are similar to those laid out in the group’s Project 2025 agenda.  Heritage Foundation’s president, Kevin Roberts, have also been speaking guests at summits and assemblies of far-right groups such as Patriots for Europe. | Jim Lo Scalzo/EPA In Italy, two MPs have proposed legislation granting fetal personhood, which would make abortion impossible. The regional government in Lazio is preparing to approve a law that would guarantee protection of the fetus “from conception,” echoing a similar push in the US. And Rocella, Meloni’s family minister who appeared last month with Heritage’s Severino, is attempting to block a regional law banning conscientious objectors from roles in clinics providing abortions.  It’s not just reproductive rights. Meloni’s government has pulled out of a memorandum of understanding on the Belt and Road Initiative, the Chinese government’s ambitious program that aims to finance over $1 trillion in infrastructure investments. It effectively blocked Chinese telecoms giant Huawei from being a part in telecommunications development.  Lucio Malan, an MP in Meloni’s Brothers of Italy party and a panelist at two conferences organized with the Heritage Foundation, attempted to reverse a ban on homophobic and sexist advertisements — though he told POLITICO he took part in the events on the invitation of the center-right FareFuturo think tank, which co-organized the events with Heritage.   Heritage and its allies in the Trump administration have everything to gain from stronger nationalist parties in Europe, which are also pushing for delays in climate and agriculture regulations and sided with the US and Big Tech on digital regulation. Earlier this year, Heritage hosted the presentation of proposals by two far-right European think tanks, Hungary’s Mathias Corvinus Collegium (MCC) and Poland’s Ordo Iuris Institute for Legal Culture, to overhaul and hollow out the EU, undermining the commission and the European Court of Justice. And Heritage’s activity in Europe comes as the organization faces a swirl of controversy back home after Roberts sided with right-wing political commentator Tucker Carlson over criticism for interviewing a white nationalist. The incident triggered an open revolt against Roberts, who subsequently apologized. The unexpectedly swift and wide-ranging implementation of Project 2025 in the U.S. has boosted Heritage’s credentials in Europe, said Kenneth Haar of Corporate Europe Observatory, a non-profit that monitors lobbying in the EU. “Trump’s wholesale adoption of their agenda has given them unparalleled status,” he said. Now, Haar added, Heritage “is not just a think tank from the U.S., it is a representative of the MAGA coalition. It is not an exaggeration to say they are carrying out foreign policy on behalf of the president.” But the Heritage Foundation’s European mission comes as far-right groups gain ground across Europe by tapping public frustration over issues such as immigration, climate policy and sovereignty and pushing policies that are similar to those laid out in the group’s Project 2025 agenda. | Shawn Thew/EPA For Heritage, there’s good reason to focus on Europe in particular: It has become a focal point for the group’s donors and activists in the U.S., who fret about perceived Islamicization and leftist politics on the continent.  “We have an existential interest in having Europe be sovereign and free and strong,” Gonzalez told POLITICO. A RALLYING POINT Historically, Europe’s right has struggled to cooperate, with different factions representing conflicting national interests. But the machinery underpinning Trump’s reelection, and his ability to move national policy in European capitals, has shifted those dynamics, making Heritage “a factor in uniting the European right,” Haar said.  “MAGA has become a rallying point, the European right is meeting more frequently,” he added. Trump’s support for their policies also gives them more “clout” in Europe, he said, as Europe’s leaders seek favor from Trump and his allies across a range of issues, including tariffs.  Transparency activists said that they’re seeing a notable uptick in activity that suggests Heritage is gaining traction beyond symposiums and events.  Raphaël Kergueno, Senior Policy Officer at Transparency International, a NGO advocating against undue political influence, said the group’s activities — including those undeclared meetings with MEPs, which may put those members in breach of the European Parliament’s code of conduct — underscores the weakness of European rules on lobbying and advocacy.  Kenneth Haar added, Heritage “is not just a think tank from the U.S., it is a representative of the MAGA coalition. It is not an exaggeration to say they are carrying out foreign policy on behalf of the president.” | Shawn Thew/EPA “The Heritage Foundation has pushed blatantly anti-democratic projects, and is now free to court MEPs without disclosing its goals or funding,” he said. “If the EU does not clean up its act, it will allow hostile actors to import authoritarianism through the backdoor.” But Nicola Procaccini, an MEP in Meloni’s party who has held several meetings with Heritage, dismissed the idea that Heritage presents a danger to the rule of law or to European politics. He said he has not read Project 2025, and pointed to the group’s long history as an economic policy powerhouse — though that has changed in the Trump era, as the group’s new head Roberts has pivoted closer to Trump.  Nevertheless, he said, “You can share or not share their views … but Heritage is certainly an authoritative voice.”  

LONDON — Officials in Brussels have stalled new Brexit reset talks after EU countries clashed over the issue of British payments to the bloc.  Ambassadors from the bloc’s 27 member states on Friday failed to give the green light for negotiations on linking U.K. and EU emissions trading systems (ETS), as well as talks on an agri-food deal. Talks are set to resume on Tuesday.  The U.K. and EU agreed in principle to negotiate on the two topics at a summit in May. But only once member states give their approval can talks truly begin. The delay is a setback for British negotiators, who had hoped to get an ETS deal in place before the EU implements its new carbon border tax regime in the New Year. Without a deal in place by the end of December, British firms exporting carbon-intensive goods to the EU such as steel and cement will be hit by the taxes from Jan. 1. One EU diplomat with knowledge of Friday’s talks confirmed there was disagreement over the issue of how much the U.K. should pay to participate in the EU’s single market. A second official confirmed there was “political sensitivity” on the issue, with specific concerns over when the U.K. would be expected to pay.  “[Should it be] on the occasion of the next electricity trading agreement, as the majority of member states suggest? Or after that, as some member states still claim,” they said.  The same official added that there was also “frustration that other talks are lagging behind” on the more contentious issue of youth mobility. Both officials were granted anonymity in order to speak freely about the ongoing talks.  CARBON TAX HIT Adam Berman, director of policy and advocacy at Energy UK, said it was now “not realistic” that a linkage negotiation would be completed by the end of the year. This will be “problematic” for British firms, Berman said, which will suddenly be subject to the new tax from Jan. 1, with the energy sector likely to be hit the hardest. But it could also harm the EU, which could see emissions increase as it seeks to replace relatively “cleaner” U.K. imports. Meanwhile, the U.K.’s EU Relations Minister Nick Thomas-Symonds has said he wants a Sanitary and Phytosanitary deal — which would see the U.K. align with EU agri-food standards — up and running by 2027. | Stefan Rousseau/PA Images via Getty Images Another headache for both sides is the fact the new regime will apply in Northern Ireland, which has no hard border with the EU, meaning the region could become a backdoor into the EU market for high-carbon goods. Berman said there was speculation of a time-limited exemption from CBAM while the U.K. was in linkage negotiations with the EU. “The big question is — Can both sides have an honest conversation about what the implications might be if there isn’t an exemption from the beginning of next year?” he said. Nevertheless, Berman is hopeful of an eventual agreement, pointing out that the issue of ETS was “not highly politicized” like other, more contentious aspects of the reset like youth mobility. “There is a pretty high level of alignment between these two policy mechanisms in the U.K. and the EU and high levels of environmental ambition on both sides. So really there are more technical questions to resolve than there are political questions, which bodes well for the likelihood of an eventual positive outcome.” AGRI-FOODS DEAL Meanwhile, the U.K.’s EU Relations Minister Nick Thomas-Symonds has said he wants a Sanitary and Phytosanitary deal — which would see the U.K. align with EU agri-food standards — up and running by 2027. To meet this timeline, talks with the EU would need to be wrapped up sometime in 2026 so parliament has time to enact legislation.   The U.K. is also racing to negotiate a deal to join the EU’s €150 billion rearmament scheme by “mid-November.” EU member countries have until the end of November to submit their own plans detailing how they would spend their allotted shares of the €150 billion in loans.  London fears that, if the U.K. isn’t in the room when that happens, it could end up losing out. The issue of Britain offering financial payments to the bloc is also politically sensitive for the U.K. Responding to the reports, a spokesperson for Britain’s right-wing Conservative Party said the government’s post-Brexit reset had “turned out to be an outrageous hit job on British taxpayers, with demands from the EU for billions of pounds from our country.” “Starmer doesn’t have the backbone to stand up to Brussels, with their attempt to extort cash from us as a punishment for having the foresight to leave the EU,” they added.

Disclaimer: POLITICAL ADVERTISEMENT * The sponsor is Polish Electricity Association (PKEE) * The advertisement is linked to policy advocacy on energy transition, electricity market design, and industrial competitiveness in the EU. More information here The European Union is entering a decisive decade for its energy transformation. With the international race for clean technologies accelerating, geopolitical tensions reshaping markets and competition from other major global economies intensifying, how the EU approaches the transition will determine its economic future. If managed strategically, the EU can drive competitiveness, growth and resilience. If mismanaged, Europe risks losing its industrial base, jobs and global influence.  > If managed strategically, the EU can drive competitiveness, growth and > resilience. If mismanaged, Europe risks losing its industrial base, jobs and > global influence. This message resonated strongly during PKEE Energy Day 2025, held in Brussels on October 14, which brought together more than 350 European policymakers, industry leaders and experts under the theme “Secure, competitive and clean: is Europe delivering on its energy promise?”. One conclusion was clear: the energy transition must serve the economy, not the other way around.  Laurent Louis Photography for PKEE The power sector: the backbone of Europe’s industrial future  The future of European competitiveness will be shaped by its power sector. Without a successful transformation of electricity generation and distribution, other sectors — from steel and chemicals to mobility and digital — will fail to decarbonize. This point was emphasized by Konrad Wojnarowski, Poland’s deputy minister of energy, who described electricity as “vital to development and competitiveness.”  “Transforming Poland’s energy sector is a major technological and financial challenge — but we are on the right track,” he said. “Success depends on maintaining the right pace of change and providing strong support for innovation.” Wojnarowski also underlined that only close cooperation between governments, industry and academia can create the conditions for a secure, competitive and sustainable energy future.  Flexibility: the strategic enabler  The shift to a renewables-based system requires more than capacity additions — it demands a fundamental redesign of how electricity is produced, managed and consumed. Dariusz Marzec, president of the Polish Electricity Association (PKEE) and CEO of PGE Polska Grupa Energetyczna, called flexibility “the Holy Grail of the power sector.”  Speaking at the event, Marzec also stated “It’s not about generating electricity continuously, regardless of demand. It’s about generating it when it’s needed and making the price attractive. Our mission, as part of the European economy, is to strengthen competitiveness and ensure energy security for all consumers – not just to pursue climate goals for their own sake. Without a responsible approach to the transition, many industries could relocate outside Europe.”  The message is clear: the clean energy shift must balance environmental ambition with economic reality. Europe cannot afford to treat decarbonization as an isolated goal — it must integrate it into a broader industrial strategy.  > The message is clear: the clean energy shift must balance environmental > ambition with economic reality. The next decade will define success  While Europe’s climate neutrality target for 2050 remains a cornerstone of EU policy, the next five to ten years will determine whether the continent remains globally competitive. Grzegorz Lot, CEO of TAURON Polska Energia and vice-president of PKEE, warned that technology is advancing too quickly for policymakers to rely solely on long-term milestones.  “Technology is evolving too fast to think of the transition only in terms of 2050. Our strategy is to act now — over the next year, five years, or decade,” Lot said. He pointed to the expected sharp decline in coal consumption over the next three years and called for immediate investment in proven technologies, particularly onshore wind.  Lot also raised concerns about structural barriers. “Today, around 30 percent of the price of electricity is made up of taxes. If we want affordable energy and a competitive economy, this must change,” he argued.  Consumers and regulation: the overlooked pillars  A successful energy transition cannot rely solely on investment and infrastructure. It also depends on regulatory stability and consumer participation. “Maintaining competitiveness requires not only investment in green technologies but also a stable regulatory environment and active consumer engagement,” Lot said.  He highlighted the potential of dynamic tariffs, which incentivize demand-side flexibility. “Customers who adjust their consumption to market conditions can pay below the regulated price level. If we want cheap energy, we must learn to follow nature — consuming and storing electricity when the sun shines or the wind blows.”  Strategic investments for resilience  The energy transition is more than a climate necessity. It is a strategic requirement for Europe’s security and economic autonomy. Marek Lelątko, vice-president of Enea, stressed that customer- and market-oriented investment is essential. “We are investing in renewables, modern gas-fired units and energy storage because they allow us to ensure supply stability, affordable prices and greater energy security,” he said.  Grzegorz Kinelski, CEO of Enea and vice-president of PKEE, added: “We must stay on the fast track we are already on. Investments in renewables, storage and CCGT [combined cycle gas turbine] units will not only enhance energy security but also support economic growth and help keep energy prices affordable for Polish consumers.”  The power sector must now be recognized as a strategic enabler of Europe’s industrial future — on par with semiconductors, critical raw materials and defense. As Dariusz Marzec puts it: “The energy transition is not a choice — it is a necessity. But its success will determine more than whether we meet climate targets. It will decide whether Europe remains competitive, prosperous and economically independent in a rapidly changing world.”  > The power sector must now be recognized as a strategic enabler of Europe’s > industrial future — on par with semiconductors, critical raw materials and > defense. Measurable progress, but more is needed  Progress is visible. The power sector accounts for around 30 percent of EU emissions but has already delivered 75 percent of all Emissions Trading System reductions. By 2025, 72 percent of Europe’s electricity will come from low-carbon sources, while fossil fuels will fall to a historic low of 28 percent. And in Poland, in June, renewable energy generation overtook coal for the first time in history.  Still, ambition alone is not enough. In his closing remarks, Marcin Laskowski, vice-president of PKEE and executive vice-president for regulatory affairs at PGE Polska Grupa Energetyczna, stressed the link between the power sector and Europe’s broader economic transformation. “The EU’s economic transformation will only succeed if the energy transition succeeds — safely, sustainably and with attractive investment conditions,” he said. “It is the power sector that must deliver solutions to decarbonize industries such as steel, chemicals and food production.”  A collective European project  The event in Brussels — with the participation of many high-level speakers, including Mechthild Wörsdörfer, deputy director general of DG ENER; Tsvetelina Penkova, member of the European Parliament and vice-chair of the Committee on Industry, Research and Energy; Thomas Pellerin-Carlin, member of the European Parliament; Catherine MacGregor; CEO of ENGIE and vice-president of Eurelectric; and Claude Turmes, former minister of energy of Luxembourg — highlighted a common understanding: the energy transition is not an isolated environmental policy, it is a strategic industrial project. Its success will depend on coordinated action across EU institutions, national governments and industry, as well as predictable regulation and financing.  Europe’s ability to remain competitive, resilient and prosperous will hinge on whether its power sector is treated not as a cost to be managed, but as a foundation to be strengthened. The next decade is a window of opportunity — and the choices made today will shape Europe’s economic landscape for decades to come. 

The Court of Justice of the European Union ruled Thursday that pets can be considered “baggage,” dealing a setback to pet owners seeking higher compensation for animals lost during international flights. The decision comes from a case in which a dog escaped from its pet-carrier at Buenos Aires airport in October 2019 and was never recovered. Its owner had sought €5,000 in compensation from Iberia airlines, which admitted the loss but argued that liability is limited under EU rules for checked baggage. The high court concluded that the 1999 Montreal Convention, which governs airline liability for baggage, applies to all items transported in the hold, including pets. While EU and Spanish laws recognize animals as sentient beings, the Luxembourg-based court emphasized that the Montreal Convention’s framework is focused on material compensation for lost or damaged items. Airlines are therefore not obligated to pay amounts exceeding the compensation caps set under the Montreal Convention unless passengers declare a “special interest” in the item, a mechanism designed for inanimate belongings. “The court finds that pets are not excluded from the concept of ‘baggage’. Even though the ordinary meaning of the word ‘baggage’ refers to objects, this alone does not lead to the conclusion that pets fall outside that concept,” the court said in a statement. Thursday’s ruling reaffirms the current framework, limiting airlines’ liability for lost pets unless passengers make a special declaration to raise coverage. For airlines operating in Europe, it offers legal certainty and shields them from larger claims. The court’s judgment will guide national courts in balancing international air transport law with EU animal welfare standards.

BRUSSELS — Fresh European Union rules intended to improve transparency around online advertisements have sparked a wave of criticism, as major platforms shut down political ads instead of complying. Campaigners say the law will cause a harmful loss of information after it triggered companies including Google, Meta and Microsoft to implement a blackout on political advertising. Politicians on both sides of the aisle said it could be detrimental to democratic debate. The Commission said it is aware of the serious concerns and is continuing talks with Big Tech companies to mitigate the unintended impacts. At the heart of the EU’s attempt is a bid to curb political manipulation and foreign interference during elections. The new law on Transparency and Targeting of Political Advertising, which kicked in on Friday, brings new restrictions and transparency requirements for paid political ads. Since the law was agreed, Google, Meta and Microsoft have all opted to stop showing political ads in the EU altogether. “Smaller, newer parties and independent candidates will lose an affordable channel to reach voters, while large, well-followed accounts remain largely unaffected,” said liberal Slovak EU lawmaker Veronika Cifrová Ostrihoňová. “That shift risks narrowing who can be heard and makes campaigning harder for newcomers.” She said that by axing political advertising, platforms are “taking the easier route,” which she regards as “a worrying signal” of tech firms refusing to seek compromises with rule makers. Among the requirements, the law demands that platforms provide information on what election, referendum or legislative process the ad is linked to, how much it cost and details on any targeting techniques used.  In announcing their decisions, Google said the definition of political advertising is too broad, while Meta criticized targeted ad restrictions that ignore the “benefits [of personalized ads] to advertisers and the people they want to reach.” Polish hard-right member of the European Parliament Piotr Müller said the rules are an example of over-regulation gone wild. “The political market will be consolidated, with large, well-known parties having the resources to meet the new requirements. This undermines pluralism and freedom of public debate,” he said. Others think the blackout will benefit fringe politicians with more extreme views, to the detriment of those with moderate messaging.  “You cannot get 50 million views for boring policy videos. If your politicians do not have social media rizz, I think it disadvantages them now,” said Sam Jeffers, executive director and co-founder of WhoTargetsMe, a non-profit that tracks online campaigning. Jeffers added that researchers risk losing access to political history as they lose visibility over data on the ads. “Seven years of historical data is gone” from Google’s political advertising library, he said, as it no longer includes the EU as a supported region. In announcing their decisions, Google said the definition of political advertising is too broad. | Wallace Woon/EPA “That for me was quite a chilling interpretation of this law,” he said, expressing concern that the same might happen to Meta’s database. Google said in response that ads that would previously have been shown on its dedicated EU political ads transparency database will remain publicly available in its main advertising pages, subject to retention policies. Google’s Ads library still contains information on at least some political ads, POLITICO found, but it seems to be mostly restricted to the previous year — which would be in line with the EU’s Digital Services Act requirements. The available information is also not as extensive as for other jurisdictions, and excludes for example the amount of money spent on ads.  BEYOND POLITICS Companies have criticized a lack of guidance and clarity from the EU executive. The Commission published guidelines on the law this week, just two days before it took effect.   Based on the definition of political advertising, Meta also blocked “social issue” ads, while Microsoft won’t run “issue-based advertising.” That could include ads about climate change, migration, social justice and human rights initiatives or any “politically sensitive or socially divisive issue,” Microsoft said. The law’s definition covers anything meant to influence the outcome of an election, referendum, vote or legislative process — which could include campaigns by charities and civil society. Small organizations that are “essential” to EU democracy will see their campaign and fundraising options limited, said Eoin Dubsky, senior campaign manager for advocacy group Eko.   The Commission only clarified this week that awareness or fundraising campaigns by NGOs shouldn’t always be considered political ads. Commission spokesperson Markus Lammert defended the law, underlining in a comment for this article that it “does not ban political advertising.” Lammert said Google and Meta are “private companies and their commercial decisions on the services and products they choose to offer are theirs to make,” but that the Commission is also aware of serious concerns from civil society about the impact. A group of civil society organizations have written open letters to Meta and Google, calling for the companies to reconsider their decisions to block political ads in the EU. Based on the definition of political advertising, Meta also blocked “social issue” ads, while Microsoft won’t run “issue-based advertising.” | Olivier Hoslet/EPA The Commission’s Lammert said it is in contact with stakeholders and national governments to “assess the possible impact of Meta’s commercial decision,” and will continue discussions with both companies on the topic. It will also hold talks in 2026 to “learn from the experiences at that point and draw insights as necessary.” For some, the furore is an unwelcome distraction as the EU grapples with enforcing other regulations — most notably its Digital Services Act to regulate content on social media platforms, which already includes requirements on advertising transparency. The Commission should focus on tackling “toxic algorithms that push propaganda ahead of facts” and bombard users with “outrageous content” rather than “information they actually want,” said German Greens lawmaker Alexandra Geese.

Epilepsy affects 50 million people globally and 6 million in the EU.1 Despite this, it is a chronically underfunded and underserved condition in need of strategic investment. The latest report from Headway1 — a survey dedicated to tracking and analysing epilepsy care in the EU — underscores the urgent funding gap across the EU in epilepsy care. At the launch of the latest report in Brussels, members of the European Parliament, advocacy and patient organizations, key industry leaders, and I discussed the current picture painted by the report, and the decisions we must make to support the European epilepsy community.  Overcoming barriers to epilepsy care  Epilepsy continues to be one of the most significant neurological conditions across Europe. As the fourth most common neurological disorder,2 it takes a startling toll on people’s health. People with epilepsy tend to have more physical problems (such as fractures and bruising from injuries related to seizures), as well as higher rates of psychological conditions, including anxiety and depression.3 Defined as a chronic non-communicable neurological disease, epilepsy is characterized by unprovoked seizures often associated with neurobiological, cognitive and social consequences.4   Despite the size of the patient population, the condition is often hidden and therefore heavily stigmatized, with such stigma contributing to a crisis of care. Nearly 40 percent of people living with epilepsy in Europe remain untreated, a figure that rises as high as 90 percent in underserved areas.5 Moreover, individuals with epilepsy have more than a twofold increased risk of premature death compared with the general population, and their life expectancy is reduced by approximately 10-12 years.6   > Individuals with epilepsy have more than a twofold increased risk of premature > death compared with the general population, and their life expectancy is > reduced by approximately 10-12 years. Epilepsy is not currently recognized in some countries as a brain disorder, and while new treatments have been coming to the EU, the scarce investment in brain health impacts access to care, which is already unequal — subject to geographic lottery, socioeconomic status and gender. Additionally, the stigma associated with epilepsy, alongside limited seizure control, significantly hinders social and economic inclusion, resulting in individuals with epilepsy feeling isolated, engaged in lower employment rates and without long-term financial security.   Addressing these barriers is not just a healthcare imperative, but a societal one  via Angelini Pharma Embracing brain capital  Central to the Headway report is the concept of ‘brain capital’. This framework underscores that investing in brain health, including epilepsy, is a robust economic strategy. Avoidable epilepsy-related costs are estimated to reach €49.2 billion annually within the EU27 and the U.K., which is approximately 0.28 percent of the combined GDP of the EU and the U.K.. These figures include €20.1 billion in direct costs and €29 billion in indirect costs.7   > Avoidable epilepsy-related costs are estimated to reach €49.2 billion annually > within the EU27 and the U.K., which is approximately 0.28 percent of the > combined GDP of the EU and the U.K. The Headway report outlines three return-on-investment models that address both the human and financial costs:  1. Closing the treatment gap by ensuring timely access to appropriate care could yield a return on investment of €1.9 for every €1 invested.8,9,10  2. Addressing psychiatric comorbidities, such as anxiety and depression, by integrating mental health support into standard epilepsy care can offer a return of €1.5 per €1 spent.11,12 This intervention is critical, as mental health disorders often exacerbate the challenges faced by individuals with epilepsy.  3. Preventing avoidable cases through public health strategies such as stroke prevention and improved perinatal care could present a return of €1.7 per €1 spent.13   If national health systems across the EU and the U.K. invest €1 in each of these targeted actions and allocate a larger portion of their total national healthcare budgets to brain health services such as diagnostics testing, hospitalizations and antiseizure medications, to name a few, it’s obvious that it repays itself. It also yields an additional €0.50-€0.90 in reduced healthcare spending and increased productivity of patients and caregivers. In a climate of tight healthcare budgets and growing demand, these findings provide an evidence-based roadmap to better care and stronger systems.  A unified approach to a healthier future  The Headway report is a clear wake-up call for European policymakers to prioritize epilepsy as part of the broader brain health agenda. By investing in epilepsy care and engaging the public, countries will not only improve individual health outcomes but also realize substantial economic and societal benefits in both the short and long term. Moreover, they can lead the way in global best practice by scaling up proven solutions such as deploying epilepsy-specialist nurses and modernizing clinical trial regulations, especially for complex studies, to promote person-centered care and improve outcomes.  > By investing in epilepsy care and engaging the public, countries will not only > improve individual health outcomes but also realize substantial economic and > societal benefits. Countries should establish dedicated additional funding for epilepsy and brain health research within the forthcoming EU Brain Health Partnership and Horizon Europe. Additionally, strengthening cross-border networks like EpiCARE and aligning with the World Health Organization’s IGAP framework will support EU member states and the U.K. in implementing effective national responses, improve access to highly specialized care and shared expertise, and knowledge from the inclusion of patient-reported indicators and real-world evidence. Epilepsy should be included as a distinct priority in the EU’s and member states’ mental health strategies with tailored indicators and goals for the best possible outcomes.  > The Headway report lay the foundation for a clear path to a more resilient and > inclusive society, one that ensures a future where every individual living > with epilepsy has the opportunity to thrive. The EU27 and the U.K. stand at a crossroads. The research we’ve done, the insights we’ve discussed in Brussels and the findings outlined clearly in the Headway report lay the foundation for a clear path to a more resilient and inclusive society, one that ensures a future where every individual living with epilepsy has the opportunity to thrive. The need now is for committed action. It is crucial that policymakers, medical and healthcare professionals, and those living with epilepsy come together to effect change, improve access to treatment and turn our vision into reality.  > -------------------------------------------------------------------------------- 1. Szaflaraski M (2014), “Social determinants of health in epilepsy” 2. TEHA on GBD 2021 Nervous System Disorders Collaborators (2024), “Global, regional, and national burden of disorders affecting the nervous system, 1990-2021: a systemic analysis for the Global Burden of Disease Study 2021,” 2025 3. World Health Organisation. Epilepsy. Signs and Symptoms. Available online here: https://www.who.int/news-room/fact-sheets/detail/epilepsy. (Accessed August 2025] 4. Fisher RS, et al. Epilepsia 2014;55: 475-482 5. IBE, ILAE, WHO (2011), “Epilepsy in the WHO European Region.” and European Parliament (2011), “Proceedings of the workshop ‘Treating and living with Epilepsy’” 6. Thurman DJ et al. (2014), “The burden of premature mortality of epilepsy in high-income countries: A systematic review from the Mortality Task Force of the International League Against Epilepsy”. Epilepsia. 7. TEHA on Begley C et al. (2022), “The global cost of epilepsy: A systematic review and extrapolation”, Strzelczyk et al. (2015), “Costs of epilepsy and cost‐driving factors in children, adolescents, and their caregivers in Germany”, and Willems LM et al. (2021), “Multicenter, cross-sectional study of the costs of illness andcost-driving factors in adult patients with epilepsy”, 2025 8. Kwon C et al. (2022), “The worldwide epilepsy treatment gap: A systematic review and recommendations for revised definitions – A report from the ILAE Epidemiology Commission”. Epilepsia. 9. De Zélicourt M et al. (2014), “Management of focal epilepsy in adults treated with polytherapy in France: The direct cost of drug resistance (ESPERA study)”. Seizure. 10. Willems LM et al. (2022), “Multicenter, cross-sectional study of the costs of illness and cost-driving factors in adult patients with epilepsy”. Epilepsia 11. Dewhurst E et al. (2015), “A prospective service evaluation of acceptance and commitment therapy for patients with refractory epilepsy”. Epilepsy & Behavior. 12. TEHA Group elaboration on OECD data and Fleishman JA et al. (2006), “Using the SF-12 health status measure to improve predictions of medical expenditures”. Medical Care 13. The European House of Ambrosetti and Angelini Pharma. (2025) Brain Health in Uncertain Times: A strategic investment for Europe’s future