Dr. Daniel Steiners This is not an obituary for Germany’s economic standing. It is an invitation to shift perspective: away from the language of crisis and toward a clearer view of our opportunities — and toward the confidence that we have more capacity to shape our future than the mood indicators might suggest. For years, Germany seemed to be traveling along a self-evident path of success: growth, prosperity, the title of export champion. But that framework is beginning to fray. Other countries are catching up. Parts of our industrial base appear vulnerable to the pressures of transformation. And global dependencies are turning into strategic vulnerabilities. In short, the German model of success is under strain. Yet a glance at Europe’s economic history suggests that moments like these can also contain enormous potential — if strategic thinking and decisive action come together. One example, which I find particularly striking, takes us back to 1900. At the time, André and Édouard Michelin were producing tires in a relatively small market, when the automobile itself was still a niche product. They could have focused simply on improving their product. Instead, they thought bigger; not in silos, but in systems. With the Michelin Guide, they created incentives and orientation for greater mobility: workshop directories, road maps, and recommendations for hotels and restaurants made travel more predictable and attractive. What began as a service booklet for motorists gradually evolved into an entire ecosystem — and eventually into a globally recognized benchmark for quality. > In times of change, those who recognize connections and are willing to shape > them strategically can transform uncertainty into lasting strength. What makes this example remarkable is that the real innovation did not lie in the tire itself or merely even a clever marketing idea to boost sales. It lay in something more fundamental: connected thinking and ecosystem thinking. The decision to see mobility as a broad space for value creation. It was the courage to break out of silos, to recognize strategic connections, to deepen value chains — and to help define the standards of an emerging market. That is precisely the lesson that remains relevant today, including for policymakers. In times of change, those who recognize connections and are willing to shape them strategically can transform uncertainty into lasting strength. Germany’s industrial health economy is still too often viewed in public debate in narrowly sectoral terms — primarily through the lens of health care provision and costs. Strategically, however, it has long been an industrial ecosystem that spans research, development, manufacturing, digital innovation, exports and highly skilled employment. Just as Michelin helped shape the ecosystem of mobility, Germany can think of health as a comprehensive domain of value creation. The industrial health economy: cost driver or engine of growth? Yes, medicines cost money. In 2024, Germany’s statutory health insurance system spent around €55 billion on pharmaceuticals. But much of that increase reflects medical progress and the need for appropriate care in an aging society with changing disease patterns. Innovative therapies benefit both patients and the health system. They can improve quality and length of life while shifting treatment from hospitals into outpatient care or even into patients’ homes. They raise efficiency in the system, reduce downstream costs and support workforce participation. > In short, the industrial health economy is not merely part of our health care > system. It is a key industry, underpinning economic strength, prosperity and > the financing of our social security systems. Despite public perception, pharmaceutical spending has remained remarkably stable for years, accounting for roughly 12 percent of total expenditures in the statutory health insurance system. That figure also includes generics — medicines that enter the ‘world heritage of pharmacy’ after patent protection expires and remain available at low cost. Truly innovative, patent-protected medicines account for only about seven percent of total spending. Against these costs stands an economic sector in which Germany continues to hold a leading international position. With around 1.1 million employees and value creation exceeding €190 billion, the industrial health economy is among the largest sectors of the German economy. Its high-tech products, bearing the Made in Germany label, are in demand worldwide and contribute significantly to Germany’s export surplus. In short, the industrial health economy is not merely part of our health care system. It is a key industry, underpinning economic strength, prosperity and the financing of our social security systems. Its overall balance is positive. The central question, therefore, is this: how can we unlock its untapped potential? And what would it mean for Germany if we fail to recognize these opportunities while economic and innovative capacity increasingly shifts elsewhere? Global dynamics leave little room for hesitation Governments around the world have long recognized the strategic importance of the industrial health economy — for health care, for economic growth and for national security. China is demonstrating remarkable speed in scaling and implementing biotechnology. The United States, meanwhile, illustrates how determined industrial policy can look in practice. Regulatory authorities are being modernized, approval procedures accelerated and bureaucratic barriers systematically reduced. At the same time, domestic production is being strategically strengthened. Speed and market size act as magnets for capital — especially in a sector where research is extraordinarily capital-intensive and requires long-term planning security. When innovation-friendly conditions and economic recognition of innovation meet a large, well-funded market, global shifts follow. Today roughly 50 percent of the global pharmaceutical market is located in the United States, about 23 percent in Europe — and only 4 to 5 percent in Germany. This distribution is no coincidence; it reflects differences in economic and regulatory environments. At the same time, political pressure is growing on countries that benefit from the American innovation engine without offering an equally attractive home market or recognizing the value of innovation in comparable ways. Discussions around a Most Favored Nation approach or other trade policy instruments are moving in precisely that direction — and they affect Europe and Germany directly. For Germany, the implications are clear. Those who want to attract investment must strengthen their competitiveness. Those who want to ensure reliable health care must appropriately reward new therapies. Otherwise, these global dynamics will inevitably affect both the economy and health care at home. Already today, roughly one in four medicines introduced in the United States between 2014 and 2023 is not available in Europe. The gap is even larger for gene and cell therapies. The primacy of industrial policy: from consensus to action — now Germany does not lack potential or substance. We still have a strong industrial base, a tradition of invention, outstanding universities and research institutions, and a private sector willing to invest. Political initiatives such as the coalition agreement, the High-Tech Agenda and plans for a future strategy in pharmaceuticals and medical technology provide important impulses, which I strongly welcome. > A fair market environment without artificial price caps or rigid guardrails is > the strongest magnet for private capital, long-term investment and a resilient > health system. But programs must now translate into a coherent action plan for growth. We need innovation-friendly and stable framework conditions that consider health care, economic strength and national security together — as a strategic ecosystem, not as separate silos. The value of medical innovation must also be recognized in Germany. A fair market environment without artificial price caps or rigid guardrails is the strongest magnet for private capital, long-term investment and a resilient health system. Faster approval procedures, consistent digitalization and a determined reduction of bureaucracy are essential if speed is once again to become a competitive advantage and a driver of innovation. Germany can reinvent itself, of that I am convinced. With courage, strategic determination and an ambitious push for innovation. The choice now lies with us: to set the right course and unlock the potential that is already there.

BRITAIN’S LABOUR PARTY STARES INTO THE ABYSS IN ITS WELSH HEARTLAND In the old coalfields of south Wales, Britain’s center-left establishment faces being crushed by a nationalist left and populist right. POLITICO went to find out why. By DAN BLOOM and SASCHA O’SULLIVAN in Newport, South Wales Photo-Illustration by Natália Delgado/POLITICO Eluned Morgan, the Welsh first minister, stood in a sunbeam at Newport’s Victorian market and declared: “Wales is ready for a new chapter.” Many voters agree. The problem for Morgan is: few think she’ll be the one to write it. This nation of 3 million people, with its coalfields, docks, mountains and farms, is the deepest heartland of Morgan’s center-left Labour Party. Labour has topped every U.K. general election here for 104 years and presided over the Welsh parliament, the Senedd, since establishing it 27 years ago. Yet Senedd elections on May 7 threaten not only to end this world-record winning streak, but leave Welsh Labour fighting for a reason to exist. One YouGov poll in January put the party joint-fourth with the Conservatives on 10 percent, behind Welsh nationalists Plaid Cymru on 37 percent, Nigel Farage’s populist Reform UK on 23 percent and the Greens on 13 percent. Other polls are less dramatic (one last week had Reform and Plaid equal, and Labour a closer third), but the mood remains stark.  The most common projection for the 96-seat Senedd is a Plaid minority government propped up by Labour — blowing a hole in Labour’s status as the default governing party and safe vote to stop the right, and echoing recent by-elections in Caerphilly (won by Plaid) and Manchester (won by Greens). POLITICO visited south Wales and spoke to 30 politicians and officials across Labour, Plaid and Reform. | Dan Bloom/POLITICO It would raise the simple question, said a senior Welsh Labour official granted anonymity to speak frankly: “What is the point in this party?’” POLITICO visited south Wales and spoke to 30 politicians and officials across Labour, Plaid and Reform, including interviews with all three of their Welsh leaders, for this piece and an episode of the Westminster Insider podcast. The conversations painted a vivid picture of a center-left establishment fighting for survival in an election that could echo far beyond Wales. While in the 1980s Welsh Labour could unite voters against Margaret Thatcher’s Conservatives, now it is battling demographic changes, a decline in unionized heavy industry and an anti-incumbent backlash. All have killed old loyalties and habits. Squeezed by Plaid and Greens to their left and Reform to their right, some in Labour see parallels with other mainstream postwar parties facing a reckoning across Europe. This week, Germany’s conservative Christian Democrats and center-left Social Democrats lost to the Greens in the car production region of Baden-Württemberg; the latter barely scraped 5 percent. In the recent Manchester by-election, the Conservatives lost their deposit. Welsh Labour MPs fear a reckoning. One said: “We will have to start again. We rebuild. We figure out, what does Welsh Labour mean in 2026? What do we stand for?” NEW CHAPTER, SAME AUTHOR It takes Morgan 20 minutes to walk the 500 meters from Newport Market to our interview. Some passers-by flag her down; others she ambushes. We pass a baked goods shop (“Ooh, Gregg’s! That’s what I want!”) and Morgan emerges with a latte, though not with one of the chain’s famous sausage rolls. She introduces herself to one woman as “Eluned Morgan, first minister of Wales.” Her target looks vaguely bemused.  After the Covid pandemic, people are simply more aware of what the Welsh government actually does — which means Labour, as the incumbent, gets more blame when things go wrong. | Matthew Horwood/Getty Images A peer and ex-MEP who joined the Senedd in 2016, Morgan is a fixture of Wales’ Labour establishment who became first minister unopposed in August 2024 after her predecessor, Vaughan Gething, resigned over a donations scandal. “I didn’t have a mandate really, because I was just kind of thrown in,” she tells POLITICO midway up the high street. “I thought, right, I need a program, so I went out on the streets and took my program directly from the public without any filter.”  She is selling a nuts-and-bolts offer of new railway stations, a £2 bus fare cap and same-day mental health care. Morgan casts herself as the experienced option to beat what she calls the “separatists” of Plaid and the “concerning” rise of populism. She means Reform, which wants to scrap net zero targets and cut 580 Welsh civil service jobs. Yet paradoxically, she also paints herself as a vessel for change. “[People] want to see change faster,” she said in John Frost Square, named after the leader of an 1839 uprising that demanded voting rights for all men. She wants to show “delivery” and “hope.” Dimitri Batrouni, Newport Council’s Labour leader, suggested an Amazonification of politics is under way. “Our lives commercially are instant,” he said. “I want something, I order it, it’s delivered to my house … people quite naturally want that in their governments.” But after 27 years, many voters are rolling the dice on delivery elsewhere. Welsh Labour is promising to end homelessness by 2034, but previously made the same pledge by 2026. Around 6,900 people are still waiting two years or more for NHS treatment (though this figure was 10 times higher during the Covid-19 pandemic). Education rankings slumped in 2023. At Newport’s Friars Walk shopping center, retired mechanical engineer Roy Wigmore, 81, said all politicians are liars. “I’ve voted Labour all my life until now,” he said, “but I’ll probably vote for somebody else — probably Nigel Farage.” ‘SHIT, WELL, HE DIDN’T CALL ME’ Much of this anger is pointed at Westminster — which is why Labour has long tried to show a more socialist face to Wales.  It was the seat of Labour co-founder Keir Hardie as well as of Nye Bevan, who launched Britain’s National Health Service in 1948. “Welsh Labour” was born out of the first Senedd-style elections in 1999, when Plaid surged in south Wales heartlands while Tony Blair’s New Labour appealed to the middle classes. For years, this deliberate rebranding worked; Labour pulled through with the most seats even when the Tories ruled Westminster. Yet in 2024, the party boasted of “two Labour governments at both ends of the M4” — in London and in Cardiff — working in harmony. The emphasis soon flipped back when things went wrong in No. 10; Morgan promised a “red Welsh way” last May. She is “trying to find our identity again,” said the MP quoted above. Morgan appeared to disown the “both ends of the M4” approach, while declining to call it a mistake. “Look, that was a decision before I became first minister,” she said. A peer and ex-MEP who joined the Senedd in 2016, Morgan is a fixture of Wales’ Labour establishment who became first minister unopposed in August 2024 after her predecessor, Vaughan Gething, resigned over a donations scandal. | Matthew Horwood/Getty Images She tries to be playful in distancing herself from Keir Starmer. “He came down a couple of weeks ago and I was very clear with him, if you’re coming you need to bring something with you. Fair play, he brought £14 billion of investment,” she said. “If he wants to come again, he’ll have to bring me more money.” But she has also hitched herself to Starmer for now — unlike Scottish Labour leader Anas Sarwar, who has called for the PM to go. As we sat down, Morgan professed surprise at news that Sarwar called several Cabinet ministers beforehand. “Did he! Shit, well, he didn’t call me,” she said. “Look at the state of the world at the moment; actually what we need is stability,” she added. “We need the grown-ups in the room to be in charge, and I do think Keir Starmer is a grown-up.” ‘ELUNED WASN’T HAPPY’ Morgan has mounted a fightback since Plaid won October’s Caerphilly by-election.  She has hired Matt Greenough, a strategist who worked on London Mayor Sadiq Khan’s re-election campaign last year, said three people with knowledge of the appointment. One of the people said: “During Caerphilly, it became quite clear there were a lot of problems. Eluned wasn’t happy with Welsh Labour or the way the campaign was running. She did a lot of lobbying and got the Welsh executive to basically give her complete power over the campaign.” Morgan “was angry that the central party [in London] took control of the Caerphilly by-election,” another of the people added. (A Morgan ally disputed this reading of events, saying she would always take a bigger role as the election drew near, and that a wide range of Labour figures are involved in the campaign committee such as a Westminster MP, Torsten Bell.) Morgan also has more support these days from Labour’s MPs — who pushed last year for her to focus less on Plaid and more on Reform. That lobbying may have been a mistake, the MP quoted above admits now. “We were quite naive in thinking that the progressives would back us,” this MP said. Privately, Labour politicians and officials in Wales say the mood and prospects are better than the start of 2026. Though asked if Labour would win the most seats in the Senedd, Batrouni said: “Let’s look and see. It’s not looking good in the polls but … politics changes so quickly.” IT’S NOT JUST ABOUT KEIR STARMER The harsh reality is that Labour’s base in Wales began slipping long before Starmer, rooted in deindustrialization since the 1970s and 80s. Newport, near England on the M4 corridor, has a measure of prosperity that other parts of Wales do not. The 137-year-old market has had a makeover, Microsoft is building data centers and U.S. giant Vishay runs Britain’s biggest semiconductor plant. Here Labour is mostly expecting a fight between itself and Reform. At Newport’s Friars Walk shopping center, retired mechanical engineer Roy Wigmore, 81, said all politicians are liars. “I’ve voted Labour all my life until now,” he said, “but I’ll probably vote for somebody else — probably Nigel Farage.” | Jon Rowley/Getty Images Wales’ west coast and north west are more Plaid-dominated, with more Welsh speakers and independence supporters. But support for nationalists is spreading in the southern valleys. “All across the valleys you’re seeing places where Labour has dominated for 100 years plus but is now in deep, deep crisis,” said Richard Wyn Jones, professor of Welsh politics at Cardiff University. “It has long been the case that a lot of Labour supporters have had a very positive view of Plaid Cymru — they just didn’t have a reason to vote for them until now.” Wyn Jones attributes the change to trends across northern Europe, where traditional left-wing parties have been “unmoored” from working-class occupations. A growing service sector has brought more white-collar voters with socially liberal values. Carmen Smith, a 29-year-old Plaid campaigner who is the House of Lords’ youngest-ever peer, said Brexit had unhitched young, left-leaning voters from the idea of British patriotism: “There are a lot more young people identifying as Welsh rather than British.”  And after the Covid pandemic, people are simply more aware of what the Welsh government actually does — which means Labour, as the incumbent, gets more blame when things go wrong.  All the while, a left-behind contingent of socially conservative ex-Labour voters is turning to Reform UK. At the Tumble Inn, a Wetherspoons chain pub in the valley town of Pontypridd, retired gas engineer Paul Jones remembered: “You could leave one job, walk a couple of hundred yards and start another job … it was a totally different world. I wish we could get it back, but I don’t think it’s going to happen.” He hasn’t voted for years but plans to back Reform. THEY’VE BLOWN UP THE MAP All these changes will be turbocharged by a new electoral map. A previous Labour first minister, Mark Drakeford, introduced a more proportional voting system which will see voters elect six Senedd members in each of 16 super-constituencies. The results will reflect the mood better than U.K. general elections (Labour won 84 percent of Wales’ seats on a 37 percent vote share in 2024), but create a volatile outcome. In the mega-constituency for eastern Cardiff, Wyn Jones believes the six seats could be won by six parties: Labour, Plaid, Reform, the Conservatives, Greens and Liberal Democrats. Ironically, said the Labour MP quoted above, Welsh Labour is now polling so badly that it could actually win more seats under the new system than the old one. Trying to win the sixth seat in each super-constituency will hoover up many resources. The size of each patch changes how parties campaign, said Plaid’s Westminster leader Liz Savile Roberts: “We’ve had to go to places that I’ve never been to.” And the scale means activists have a weaker connection to the candidates they campaign for — compounded in Labour by many Senedd members stepping down. Just six people turned up to one recent Labour door-knocking session in a heartland seat. A left-behind contingent of socially conservative ex-Labour voters is turning to Reform UK. | Huw Fairclough/Getty Images After May 8, the new system will make coalitions or informal support deals more necessary to command a Senedd majority. Morgan declined to say if she would support Plaid’s £400 million-a-year offer to expand free childcare (which Labour says is unfunded), rather than see it voted down. “I’m certainly not getting into hypotheticals,” she said. “I’m in this to win it.”  Her rivals have other ideas. THE PRESIDENT IS COMING On the hill above Newport, a two-story presidential-style image of Rhun ap Iorwerth filled a screen at the International Convention Centre above the words: “New leadership for Wales.” The former BBC presenter, who took over Plaid’s leadership in 2023, strained not to make his February conference look like a premature victory lap. Members could’ve been fooled. They struggled to find parking. There were more lobbyists; more journalists. It is a slow burn for a party founded in 1925, which won its first Westminster seat in 1966. Ap Iorwerth ramped up the anti-establishment rhetoric in his conference speech while Lindsay Whittle, who won Caerphilly for Plaid in October’s by-election, bellowed: “Rich men from London, we are waiting for you!” Yet he insists his success is more than a protest vote, a trend sweeping Europe or a mirror of Reform’s populism. “I’d like to think that we’re doing something different,” Ap Iorwerth told POLITICO. While Morgan accuses him of “separatism,” he said: “We have a growing sense of Welsh nationhood and Welsh identity, at a time when there’s deep disillusionment in the old guard of U.K. politics and a sense of needing to keep at bay that populist right wing.” Ap Iorwerth said there is a “very real danger” that Labour vanishes entirely as a serious force in the Senedd. “The level of support that they have collapsed to is a level that most people, probably myself included, could never have imagined would happen so quickly,” he said. INDEPENDENCE DAY? But Plaid faces three big challenges to hold this pole position. The first is its ground game, stretched thin to cover the new world of mega-seats. On the hill above Newport, a two-story presidential-style image of Rhun ap Iorwerth filled a screen at the International Convention Centre above the words: “New leadership for Wales.” | Matthew Horwood/Getty Images The second is to remain distinct from Labour and the insurgent Greens while running a broad left-leaning platform focused on energy costs, childcare and the NHS. The third is to convince unionist voters that Plaid is not simply a Trojan horse for Welsh independence. Independence is Plaid’s core belief, yet Ap Iorwerth did not mention the word once in his speech, instead promising a “standing commission” to look at Wales’ future. He told POLITICO he would rather have a “sustained, engaging, deep discussion … than try to crash, bang, wallop, towards the line.”  But opponents suggest Plaid will push hard for independence if they win a second term in 2030 — like the Scottish National Party did after topping elections in 2007 then 2011. One conference attendee, Emyr Gruffydd, 36, a member for 19 years, said independence “is going to be part of our agenda in the future, definitely. But I think nation-building has to be the approach that we take in the first term.” Savile Roberts accepted that shelving talk of independence (which is still supported by less than half the Welsh population) is part of a deliberate strategy to broaden the party’s reach and keep a wide left-leaning appeal. “I mean, we know the people that we need to appeal to — it is the disenchanted Labour voters,” she said. For some shoppers in Newport — not Plaid’s home turf — it may be working. One ex-Labour voter, Rose Halford, said of Plaid: “All they want to do is make everybody speak Welsh.” But she’ll consider backing them: “They’re showing a bit more gumption, aren’t they?” TAXING QUESTIONS FOR PLAID If Plaid does win, that’s when the hard part begins. Ap Iorwerth would seek urgent talks about changing Wales’ funding formula from Westminster — but cannot say how much this would raise. And Plaid has vowed not to hike income tax, one of the few (blunt) tax instruments available to the Welsh government. Strategists looked at the issue before and feared it would prompt taxpayers to flee over the border to England. So Plaid promises vague financial “efficiencies” in areas such as child poverty, where spending exceeded £7 billion since 2022, and health. Whittle said: “There’s an awful lot of people pen-pushing in the health service. We don’t need pen-pushers.” Labour’s attack machine argues that Plaid and Reform UK alike would cut services. Ap Iorwerth insists his and Farage’s promises are different: “We’re talking about being effective and efficient.” But he admitted: “You don’t know the detail until you come into government.”  Ap Iorwerth jettisoned any suggestion that Plaid would introduce universal basic income, saying it is “not a pledge for government.” He added: “It’s something that I believe in as a principle. I don’t think we’re in a place where we have anything like a model that could be put in place now.” Ap Iorwerth would seek urgent talks about changing Wales’ funding formula from Westminster — but cannot say how much this would raise. | Matthew Horwood/Getty Images The blame game between Cardiff and Westminster will run hot. Ap Iorwerth voiced outrage this week at a leaked memo from Starmer in December, ordering his Cabinet to deliver directly in Wales and Scotland “even when devolved governments may oppose this.” FARAGE’S WELSH SURGE And then there’s Reform. Farage’s party has rocketed in the polls since 2024; typical branch meetings have swelled from a dozen members to several dozen. Since February, Reform has even had its own leader for Wales — Dan Thomas, a former Tory councillor in London who says he recently moved back to the area of Blackwood, in the south Wales valleys. Some party figures have observed a dip after the Caerphilly by-election, where Reform came second. Thomas insists: “I don’t think we’ve plateaued” — and even said there is room to increase a 31 percent vote share from one (optimistic) poll. “There’s still a Labour vote to squeeze,” he told POLITICO.  “We’re targeting all of Wales.” It is a measure of Plaid’s success that Reform UK often now presents the nationalist party as its main competition. “It’s a two-horse race [with Plaid], that’s what I say on the doors,” said Leanne Dyke, a Reform canvasser who was drinking in the Pontypridd Wetherspoons. James Evans, who is now one of Reform’s two Senedd members after he was thrown out of the Conservative group in January on suspicion of defection talks, argues his supporters are underrepresented in polling because they are “smeared” as bigots. Evans added: “Very similarly to what happened in America when Donald Trump was elected, I think there is a quiet majority of people out there who do not want to say they’re voting Reform, who will vote Reform.”  Reform has its own custom-built member app, ReformGo, as it canvasses data on where its supporters live for the first time. It sent a mass appeal by post to all registered Welsh voters in late 2025 (before spending limits kicked in). Welsh campaign director David Thomas is recruiting a brand new slate of 96 candidates, booking hotels for training days with interviews, written exercises and team-building. Daytime TV presenter Jeremy Kyle has helped with media training. English officials cross the border to help; Reform still only has three paid officials in Wales. FARAGE HAS AN NHS PROBLEM Lian Walker, a postal worker from the village of Pen-y-graig, would be a prime target for Reform. “There’s people who I see on the databases, they don’t work,” she said in Pontpridd’s Patriot pub, “but they get everything; new windows, earrings, T-shirts, shorts.” She supports Reform’s plans to deport migrants. But on the NHS, she says of Reform: “They want it to go private like America.” Labour and Plaid drive this attack line relentlessly. The full picture is more nuanced — but still exposes a tension between Farage and Thomas. But Farage has an advantage; the right is less split than the left. | Ben Birchall/PA Images via Getty Images While Reform emphasizes it would keep the NHS free at the point of use, Farage has not ruled out shifting its funding from general taxation to a French-style insurance model, saying that would be “a national decision ahead of a general election.” Thomas, however, broke from this stance. He told POLITICO: “No, no. We rule out any kind of insurance system or any kind of privatization.” He added: “Nigel’s also said that devolved issues are down to the Welsh party, and I wouldn’t consider any kind of insurance-based or private-based system for the Welsh NHS.” Labour and Plaid are relying on an anti-Reform vote to keep Farage’s party out of power. Opponents have also highlighted the jailing of Nathan Gill, Reform’s former Welsh leader, for taking bribes to give pro-Russia interviews and speeches. But Farage has an advantage; the right is less split than the left. In Evans’ sprawling rural seat of Brecon and Radnorshire, two people with knowledge of the Conservative association said its membership had fallen catastrophically from a recent peak of around 400. On the other hand, the sheer number of defections makes Reform look more like a copycat Conservative Party. A former Tory staffer works for Evans; Thomas’ press officer is the Welsh Conservatives’ former media chief. Evans said last year that 99 percent of Reform’s policies were “populist rubbish,” but was allowed to see the policy platform in secret before he agreed to join (and has since contributed to it). While the long-time former UKIP and Brexit Party politician Mark Reckless led a policy consultation in the first half of 2025, former Conservative Welsh Secretary David Jones — who defected without fanfare last year — played a hands-on role behind the scenes working up manifesto policies, two people with knowledge of his work said. THE NIGEL SHOW Then there is Reform’s reliance on Farage himself.  The party deliberately left it late before unveiling a Welsh leader, said a Reform figure in Wales, and chose in Thomas a Welsh figure who would not “detract from Nigel’s overall umbrella and brand.” While Welsh officials and politicians worked on the manifesto, Farage himself was involved in signing it off — as were several others in London, said Evans, including frontbench spokespeople Robert Jenrick, Suella Braverman and Zia Yusuf. Thomas said: “Ultimately, it’s my decision to sign off the manifesto. Of course, Nigel was consulted because he’s our U.K. leader, and we want to ensure that what’s going on in Wales is aligned to the broader picture in the UK.” Reform’s Welsh manifesto promises to cut a penny off every band of income tax by 2030, end Wales’ “nation of sanctuary” plan to support asylum seekers, scrap 20mph road speed limits and upgrade the M4 and A55 highways. But costings have not been published yet — Reform has sent them to be assessed by the Institute for Fiscal studies, a nonpartisan think tank — and like other parties, Reform faces questions about how it will all be paid for. Asked if Reform would begin work on the M4 and A55 upgrades by 2030, Thomas replied: “We’d like to. But we all know in this country, infrastructure projects take a long time.” While Welsh officials and politicians worked on the manifesto, Farage himself was involved in signing it off — as were several others in London, said Evans, including frontbench spokespeople Robert Jenrick, Suella Braverman and Zia Yusuf. | Huw Fairclough/Getty Images ‘I’VE GOT TO FOCUS ON WHAT I CAN CONTROL’ These harsh realities facing Wales’ would-be rulers are a silver lining for Labour. Morgan avoided POLITICO’s question about whether she believes the polls — “I’ve got to focus on what I can control” — but insisted many voters remain persuadable. “People will scratch the surface and say [our rivals] are not ready,” she said. Alun Michael, who led the first Welsh Labour administration in 1999, said the idea that the Labour vote has “collapsed completely” is wrong. “It’s always dangerous to go on opinion polls as a decider of what will happen in an election,” he said. Whoever does win will deserve a moment of levity. If Ap Iorwerth wins the most seats on May 7, he will drink an Aperol spritz; Thomas will have a glass of Penderyn Welsh whisky.  As for Morgan? She would like a cup of tea — milk, no sugar. Perhaps survival would be sweet enough.

As European health systems grapple with how to deliver increasingly advanced therapies, rare disease patients in Sweden still face everyday challenges — from securing a diagnosis to accessing appropriate care. Although rights are strong on paper, families often find themselves stitching together services across a decentralized system. Ågrenska is a national competence center in Sweden working to bridge those gaps. It supports people with rare diagnoses and their families in navigating health and social services. “But there’s a limit to what one organization can do,” says Zozan Sewger Kvist, Ågrenska’s CEO. POLITICO Studio spoke with her about where the Swedish system falls short and what must change across Europe to ensure patients are not left behind. POLITICO Studio: From Ågrenska’s experience working with families of rare disease patients across Sweden, where does the system most often break down? Zozan Sewger Kvist: For 25 years the families have been telling us the same thing: the system doesn’t connect. Zozan Sewger Kvist, CEO, Ågrenska The breakdown is most evident in health care, especially when transitioning from pediatric to adult care. But it also happens when patients are transitioning between schools, social services and medical teams. No one is looking at their care from a holistic point of view. Families become their own project managers. They are the ones booking appointments, chasing referrals, explaining the diagnosis again and again. It’s a heavy burden. That’s largely why our organization exists. We provide families with the knowledge, networks and tools to navigate the system and understand their rights. But there’s a limit to what one organization can do. In a perfect world, these functions would already be embedded within public care. > Without clear national coordination, it becomes much harder to monitor whether > families are actually receiving the support they are entitled to. PS: Access to rare disease care varies widely within many European countries and Sweden is no exception. In practical terms, what do those regional disparities look like? ZSK: Swedish families have the same rights across the country, but regional priorities differ. That leads to unequal access in practice. For example, areas with university hospitals tend to have stronger specialist networks and rehabilitation services. In more rural parts of the country, especially in the north, it is harder to attract expertise, and families feel that gap directly. In practical terms, that can mean something as basic as access to rehabilitation. In some regions, children receive coordinated physiotherapy, speech therapy and follow-up. In others, families struggle to access rehabilitation at all. And that’s a big issue because a lot of Sweden’s health care runs through rehabilitation — without it, referrals to other services and treatments can stall. PS: Would a comprehensive national rare disease strategy meaningfully change outcomes across regions? ZSK: The problem is compliance, not regulation. Sweden has strong rules but regions have almost full freedom to organize care, which makes consistency difficult. As it stands, without clear national coordination, it becomes much harder to monitor whether families are actually receiving the support they are entitled to. A national rare disease strategy would not solve everything but it would set expectations such as what the minimum level of care should look like, what coordination should include and how outcomes are followed up. A draft national strategy was developed in 2024, and there was real momentum. Patient organizations, health care experts and the government were all involved. Everyone was optimistic the framework would provide guidance and accountability. After some delays, work on the national strategy has resumed, so hopefully we will see it implemented soon. > Families often feel they need to take on a coordinating role themselves. They > describe an endless search — calling clinics, repeating their story, trying to > connect the dots. PS: Families often describe a long and fragmented path to diagnosis. Where does that journey tend to go wrong, and what would shorten it most? ZSK: Coordinated multidisciplinary teams would make the biggest difference — teams that can look at the whole condition, not just one symptom at a time. The challenge is that rare diseases often affect multiple organ systems. Several specialists may be involved, but they do not always work together, and it may not be clear who is taking responsibility for the whole case. When no one holds that overview, delays multiply. Sweden also lacks a fully integrated national health record system, so specialists may be looking at different pieces of the same case without seeing the full picture. Families often feel they need to take on a coordinating role themselves. They describe an endless search — calling clinics, repeating their story, trying to connect the dots. PS: Sweden participates in the European Reference Networks, yet you’ve suggested they’re underused. What’s missing in how Sweden leverages that expertise? ZSK: The ERNs are a strong, established framework for connecting specialists across borders. Swedish experts participate, but we are not using that structure to its full potential. Participation often appears project-based rather than long-term. Neighboring countries such as Norway, Denmark and Finland are more proactive in leveraging these collaborations. I would like to see Sweden invest more in turning these networks into durable partnerships that support clinical practice — not just research initiatives. > Rare disease care needs sustained political and financial follow-through. > Without that, families will continue to carry burdens that the system should > be managing. PS: Sweden often falls behind other EU countries in terms of access to orphan medicines (drugs that treat rare diseases). What needs to change in Sweden’s approach to ensure patients aren’t left behind? ZSK: Families are very aware of how access compares across Europe. They follow these discussions closely, and when a treatment is available in one country but not another, it is difficult for them to understand why. In Sweden, reimbursement decisions often come down to cost-effectiveness calculations. That makes access an ethical as well as an economic question. But for a family, it is hard to accept that a few additional years of life or stability are weighed against a financial threshold. Some families choose to cross borders for treatment. But that can be quite a complex, expensive process, depending on the kind of treatment. I think greater transparency and clearer communication about the criteria and long-term impact — not only the immediate cost — would make difficult outcomes easier to understand. PS: You’ve worked with families for decades. Have things materially improved — and what worries you most if reforms stall? ZSK: Unfortunately, I cannot say that things have materially improved. When I look back at the challenges families described 15 or 20 years ago, many of them are still the same. There have been some positive developments. Digital access means families are more informed and can connect more easily with others in similar situations. That has strengthened their voice. But structurally, many of the underlying gaps remain. Rare disease care needs sustained political and financial follow-through. Without that, families will continue to carry burdens that the system should be managing. 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.

Andrej Babiš built his fortune making fertilizer. But another, lesser-known arm of his business empire has helped bring more than 170,000 children into the world across Europe. The Czech prime minister’s name is rarely attached to FutureLife, one of Europe’s largest IVF clinic networks, spanning 60 clinics in 16 countries from Prague to Madrid to Dublin. But is just one part of a commercial empire that spans nitrogen-based fertilizers and industrial farms, assisted reproduction, online lingerie stores and more. And the Czech leader holds this portfolio while sitting at the table negotiating EU budgets, health rules and industrial policy. Yet in Brussels, nobody can answer a deceptively simple question: Which of the companies associated with Babiš receives EU money — and how much? “We might be giving him money and we don’t even know,” said Daniel Freund, a German Green lawmaker who led the European Parliament’s inquiries into Babiš during his first term as Czechia’s prime minister from 2017 to 2021. In 2021, the Parliament overwhelmingly adopted a resolution condemning Babiš over conflicts of interest involving EU subsidies and companies he founded. Under EU rules, member countries are responsible for checking conflicts of interest and reporting on who ultimately benefits from EU funds. But there is no single EU-wide register linking ultimate beneficial owners to all EU payments — making cross-border oversight difficult. The issue has resurfaced as Babiš returns to power and once again takes a seat among other EU heads of state and government in the European Council. In that exclusive body, he helps negotiate the bloc’s long-term budget, agricultural subsidies and other funding frameworks that shape the sectors in which his companies might operate. For years, debates over Babiš’s conflicts of interest have revolved around a single name — Agrofert, the agro-industrial empire that EU and Czech auditors found had improperly received over €200 million in EU and national agricultural subsidies. The payment suspensions and repayment demands continue: This week, Czech authorities halted some agricultural subsidies to Agrofert pending a fresh legal review of the company’s compliance with conflict-of-interest rules. Babiš has consistently rejected accusations of wrongdoing. His office said he “follows all binding rules” and that “there is no conflict of interests at the moment,” adding that Agrofert shares are managed by independent experts and that he “is not and will never be the owner of Agrofert shares.” In a parliamentary debate earlier this month, he dismissed the controversy as politically motivated, accusing opponents of having “invented” the conflict-of-interest issue because they were unable to defeat him at the ballot box. But critics argue that the renewed focus on Agrofert obscures a far broader commercial footprint. “Agrofert is only half of the problem,” said Petr Bartoň, chief economist at Natland, a private investment group based in Prague. “The law does not say ‘thou shalt not benefit from companies called Agrofert.’ It says you must not benefit from any companies subsidized by or receiving public money.” The concern, critics argue, arises from the sheer number of companies and sectors with which Babiš remains associated. THE INVISIBLE PILLAR Separate from Agrofert sits Hartenberg Holding, a private-equity vehicle Babiš co-founded with financier Jozef Janov in 2013. He holds a majority stake in the fund through SynBiol, a company he fully owns and which, unlike Agrofert, has not been transferred into any trust arrangement. With assets worth around €600 million, Hartenberg invests in health care, retail, aviation and real estate. Yet it has attracted only a fraction of the scrutiny directed at the agricultural holding, according to Lenka Stryalová of the Czech public-spending watchdog Hlídač státu. “Alongside Agrofert, there is a second, less visible pillar of Babiš’s business activities that is not currently intended to be placed into blind trusts,” she said. That pillar includes FutureLife, whose 2,100 specialists help individuals and couples conceive across Czechia, Slovakia, the U.K., Ireland, Romania, the Netherlands, Spain, Italy and Estonia. The clinics operate in a policy-sensitive space shaped primarily by national health reimbursement systems and insurance rules, rather than decisions taken directly in Brussels. Those systems, however, function within a broader EU regulatory framework governing cross-border care and state aid. Hartenberg owns 50.1 percent of FutureLife. The company said in a statement that Babiš has no operational role, no board seat and no decision-making authority. It added that FutureLife clinics operate like other health care providers and, where applicable, are reimbursed by national public health insurance systems under the same rules as other providers. Like thousands of other companies, some FutureLife entities received pandemic-era wage support under Czechia’s Covid relief programs. There is no evidence of any irregularity in those payments.  But health care is only one corner of the portfolio. Through Hartenberg, Babiš-linked capital also flows into everyday retail life. Astratex, a Czech-founded online lingerie retailer that began as a catalogue business before moving fully online in 2005, now operates localized e-shops across roughly 10 European markets and generates tens of millions of euros in annual revenue. Hartenberg acquired a controlling stake in 2018, marking one of the fund’s early expansions into cross-border digital retail. In Czechia, shoppers may also encounter Flamengo florist stands, a network of around 200 outlets selling bouquets, potted plants and funeral flower arrangements inside supermarkets and shopping malls. Hartenberg acquired a majority stake in the chain in 2019, backing its expansion and push into online delivery. Other online businesses linked to Babiš include sports equipment, and wool and textile retailers. Through Hartenberg, Babiš has also invested in urban development and real estate. Hartenberg was an early majority investor in the project company behind Prague’s Císařská vinice, a premium hillside development of villas and apartments near Ladronka park, partnering with developer JRD to finance construction. JRD Development Group said the project company is now 100 percent owned by JRD and that neither Babiš nor companies linked to him hold any direct or indirect ownership interest. The firm added that the development has not received EU funds or other public financial support. None of the Hartenberg businesses have ever been accused of misusing EU subsidies. But the long-running “Stork’s Nest” case, first investigated more than a decade ago and still unresolved, shows how difficult it can be to follow Babiš’s business web. The alleged fraud involved a €2 million EU subsidy provided in 2008 to the 31-room Čapí Hnízdo (Stork’s Nest) recreational and conference center in central Czechia, then part of Babiš’s Agrofert conglomerate. Prosecutors have accused Babiš and his associates of manipulating the center’s ownership and concealing his control of the business in order to obtain the subsidy. Babiš has always denied wrongdoing, telling POLITICO in 2019 that the case was politically motivated. He was acquitted in 2023, but an appeals court later overturned that verdict and ordered a retrial, which remains pending. Today, the resort itself is no longer part of Agrofert. It is owned by Imoba, a company fully controlled by Babiš’s SynBiol, the same holding that controls Hartenberg. Hartenberg itself holds no stake in Stork’s Nest. Taken together, Babis’ non-Agrofert portfolio spans health care reimbursement systems, online retail regulation, aviation safety oversight, real estate and city-planning decisions across multiple EU jurisdictions. In theory, a Czech consumer could encounter Babiš-linked companies at nearly every stage of life: the fertilizer on the fields that grow the wheat, the bread on the supermarket shelf, the bouquet for the wedding, the apartment in Prague and even the clinic that helps bring the next generation into the world. And at the end, perhaps, the flowers once more. WHY BRUSSELS CAN’T KEEP TRACK During Babiš’s previous term, the European Commission concluded that trust arrangements he put in place did not eliminate his effective control over Agrofert. A leaked legal document reported by POLITICO this month has since renewed accusations that his latest trust setup does not fully address those concerns either. Babiš rejects that interpretation, saying the arrangement complies with Czech and EU law and insisting he has done “much more than the law required” to distance himself from the company. The Commission said it does not maintain a consolidated list of companies ultimately owned or controlled by Babiš across member countries. Nor does it hold a comprehensive accounting of EU funds received by companies linked to him beyond Agrofert. Instead, responsibility for collecting beneficial ownership data lies primarily with national authorities implementing EU funds. The Commission can audit how member countries manage conflicts of interest and take measures to protect the EU budget if needed, but it does not itself aggregate that information across borders. The Commission confirmed to POLITICO that it has asked Czech authorities to explain how conflicts of interest are being prevented in relation to companies under Babiš’s control beyond Agrofert. Czech Regional Development Minister Zuzana Mrázová on Thursday acknowledged receiving the Commission’s letter earlier this month, saying it will be answered in line with applicable legislation and adding that, in her view, the prime minister has done everything necessary to comply with Czech and EU law. “From my perspective, there is no conflict of interest,” she said. Freund argues that the corporate complexity has become a problem in its own right. “The tracking of beneficial owners or beneficial recipients of EU funds is at the moment very difficult or sometimes even impossible,” said the EU lawmaker. Part of the difficulty lies in Europe’s fragmented ownership registers, which exist on paper across the EU but don’t speak the same language or even list the same owners. Freund described them as “inconsistent,” with some national databases listing Babiš in connection with certain companies while others do not. Babiš’s defenders argue that his steps regarding Agrofert go beyond what Czech law strictly requires. Critics counter that the law was never written with billionaires running multi-sector empires in mind and that resolving the conflict of interest identified by auditors in relation to Agrofert does not settle the wider concerns raised by the scale of his business interests. “For some reason, the perception has been created that once Agrofert is resolved, that resolves the conflict of interest,” Bartoň said. “As if the president were the arbiter of what needs and needs not be dealt with.” In reality, many companies owned through Hartenberg and Synbiol structures continue to operate in areas shaped by public spending, regulation and political decisions without being part of any divestment or trust arrangement. Those assets “still not only [pose] conflict of interest,” said Bartoň, but they are “not even in the process of being dealt with.” From fertilizer to fertility to funeral flowers, the structure is easy enough to trace in everyday life. It is far harder to trace on paper. Ketrin Jochecová contributed to this report.

President Donald Trump’s State of the Union address was defined in many respects not by what he said but by what he avoided saying. There were the mistakes he avoided making: Trump did not attack the Supreme Court. He did not blitz members of his own party who have criticized him. He avoided rambling, angry digressions from the script. Then there were the issues he avoided addressing: Trump offered no new ideas on housing or health care, two defining issues of the midterm campaign. He made no mention of the Jeffrey Epstein scandals consuming politics in Washington and far beyond. He did not clarify his policy toward Iran, even as he masses air and naval forces in the region. It was, for better or worse, a speech not likely to change the political trajectory of Trump’s second term. The historically long address was, in some ways, nearly indistinguishable from Trump’s daily patter in the Oval Office, on Air Force One or in the White House driveway. For some leaders in the president’s party, mindful of his capacity for political self-harm, that might be cause for relief. Republicans wake up on Wednesday morning with no political problems they did not have the day before. Yet the status quo of the midterm campaign does not favor the GOP: Trump is on the defensive on many of the issues driving the election cycle so far. That, too, did not change. “In some ways, this was Trump’s finest — it was a full patriotic projection,” said GOP strategist Matthew Bartlett, who served in Trump’s first administration. “It was aspirational, emotive. Yet in terms of a political speech there was no policy prescription that will guide Republicans towards safer ground in the midterms.” Another Republican operative, granted anonymity to discuss the president’s performance, expressed concern that the speech didn’t do enough to look forward. “It’s all look behind, as great as it all is,” the operative said. “I wish we had more detailed steps to take, directing Congress to do more for people who are hurting.” For some, Trump did exactly what he needed to do — offering plenty of red meat to a base hungry for the president to call out Democrats for their hypocrisy about inflation, blame former President Joe Biden and talk tough on illegal immigration. Steve Bannon, Trump’s former chief strategist, said talking to so-called persuadable voters is a losing strategy that failed in 2018. “Tonight changes that,” he said. “The president is not reaching out , he’s leading forward—game now on!” The speech was replete with Trump’s usual flourishes — braggadocio, hyperbole, unscripted asides and anecdotes. He talked about the wars he stopped, the prices he has helped bring down and the “hundreds of billions of dollars” he’s brought in from foreign investments through tariffs and negotiations. “We’re winning so much that we really don’t know what to do about it,” Trump said. “People are asking me, ‘please, please please, Mr. President, we’re winning too much. We can’t take it anymore. We’re not used to winning in our country until you came along. We were just always losing.’” Still, 13 months into a second term defined largely by the president’s outsized ambition and focus on personal prerogatives, be it his quest for a Nobel Peace Prize or determination to remodel and redecorate the White House complex, the remarks were also notable for their uncharacteristic restraint. The president remained disciplined even as he broke his own record for the longest State of the Union ever. There was no mention of owning or annexing Greenland, which caused international chaos and strained the transatlantic alliance, just last month. In fact, foreign policy made up a relatively small part of his remarks given what a huge part of his agenda it has been. With his approval rating stuck around 40 percent and Republicans increasingly nervous about the possibility of a midterm tsunami, Trump stuck to politically safer ground. He interspersed his remarks with several feel-good set-pieces, diverting the audience’s attention to the House balcony in an effort to rise above partisan politics: he cheered the gold-medal olympic hockey team; praised the Coast Guard rescue swimmer who saved an 11-year from the central Texas flooding, pinned medals and ribbons on war heroes and servicemen and prayed for a woman trying to conceive through IVF, whose drugs were cheaper because of TrumpRX. That last point, a focus on economic issues and affordability, was an effort to shore up a growing liability. Trump outlined the tax cuts enacted by Republicans last year and outlined additional policy proposals for Congress, urging lawmakers to aid prospective homeowners by preventing private equity firms from buying up single-family homes and to lower prescription drug costs for seniors. But with the GOP holding such slim legislative majorities and the focus quickly turning to the campaign trail, the prospects for major legislative action this year are slim. Asserting that consumer prices are coming down, Trump continued to attack Democrats as hypocrites for “suddenly” emphasizing affordability issues. “You caused that problem,” Trump said to the Democratic side of the aisle. “Their policies created the high prices. Our policies are rapidly ending them.” His hectoring, especially when he turned to immigration issues, provoked a stronger reaction from a few Democratic lawmakers who weren’t able to stay quiet. “You should be ashamed of yourselves,” Trump said to Democrats, over their refusal to fund the Department of Homeland Security. Democrats are demanding changes to how federal agents operate in the wake of the deadly shootings of protesters by Immigrations and Customs Enforcement officers carrying out raids in Minneapolis and several other cities. Reps. Rashida Tlaib (D-Mich.) and Ilhan Omar (D-Minn.) — both frequent targets of the president’s attacks — shouted back. “You have killed Americans,” Omar shouted, referencing Alex Pretti, the nurse who was killed by federal agents in Minneapolis last month. “Alex wasn’t a criminal,” she said. When some Democrats didn’t heed Trump’s call for lawmakers to stand at various points to show support for crime victims attacked by undocumented immigrants or parents seeking to prevent their children’s sexual transition, the president dismissed the entire party. “These people are crazy,” he said. “They’re crazy.” Trump looked to frame his dizzying return to the Oval Office — the upheaval caused by his predatory foreign policy, his punishing, unpredictable tariff regime and even the violence sparked by his immigration enforcement efforts — as a modern corollary to America’s original revolution, filling his speech with references to 1776 and the milestone 250th anniversary the country will mark in July. “These first 250 years were just the beginning,” Trump said as he wrapped his speech. “The golden age of America is upon us. The revolution that began in 1776 has not ended. It still continues because the flame of liberty and Independence still burns in the heart of every American patriot. And our future will be bigger, better, brighter, bolder, and more glorious than ever before.” Lisa Kashinsky, Dasha Burns, Megan Messerly and Alex Gangitano contributed to this report.

AbbVie SA/NV – BE-ABBV-260011 (V1.0) – January 2026 -------------------------------------------------------------------------------- Disclaimer POLITICAL ADVERTISEMENT * The sponsor is AbbVie Inc. * The advertisement is linked to policy advocacy around the Neurological Health Strategy. More information here.

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

After months of tight-lipped talks, the Netherlands’ new minority government unveiled a blueprint for the country’s future on Friday, promising to move beyond political squabbling and return to the long-standing Dutch tradition of consensus politics. The 67-page coalition agreement laid out a series of ambitious goals to be spearheaded by Rob Jetten and his liberal D66 party alongside his coalition partners — the center-right Christian Democratic Appeal (CDA) and the liberal People’s Party for Freedom and Democracy (VVD). “Today we’re embarking on a new course,” Jetten, told journalists in The Hague on Friday, promising “real breakthroughs.” Jetten, at age 38, is set to become the youngest Dutch prime minister. Those hoping for a dramatic shift after years of right-wing politics, however, could be disappointed. “Ultimately, we see relatively little of D66’s progressive agenda reflected in the agreement,” said Sarah de Lange, a professor of Dutch politics at Leiden University, pointing to the program’s emphasis on higher defense budgets and deregulation at the expense of social spending.  Here are five things you need to know about what Jetten’s government has in store: 1. IT WANTS US TO BELIEVE IN POLITICS AGAIN The new government is keen to signal it is making a clean break from years of political paralysis, rolling out its new Cabinet slogan: “Let’s get to work!” The not-so-subtle message here is that the three coalition members want to show they are serious about delivering on tackling the country’s main challenges, ushering in the end of an era of polarization and political clashes and returning full-force to the Netherlands’ long-standing tradition of compromise politics. After the conflict-ridden and gloomy-toned Schoof government, expect a “yes-we-can” vibe from The Hague.  2. IT’S SPLURGING ON … — Defense, allocating an extra €19 billion to meet the new NATO spending target of 5 percent of gross domestic product — 3.5 percent on core military expenditure and 1.5 percent on defense-related areas — and to facilitate the country’s transition from being a “peace dividend to combat power.” “The Netherlands is at the forefront of building a European pillar within NATO,” the coalition document reads.  — Solving the Netherlands’ housing crisis and phasing out nitrogen emissions through buyouts will also require large investments. Planned cuts to education and international aid will be put in the freezer — a win for the D66, for whose electorate those are core concerns. … AT THE EXPENSE OF …  — Social spending will take a big hit, with Dutch citizens expected to shoulder more of the burden for health costs.  “We’re preventing a huge explosion of the health care budget, which creates room to invest in defense and national security,” Jetten explained on Friday.   — The coalition document also stipulates a “freedom contribution,” a tax of about €184 per citizen per year which is meant to raise some €3.4 billion toward defense.  3. IT WILL STAY FIRM ON MIGRATION The previous government fell over migration, which remained a major campaign issue in the run-up to the election. Jetten positioned himself as the antithesis to far-right firebrand Geert Wilders, whose Party for Freedom has long claimed the topic. In the coalition text, the new government walks the tightrope of promising a strict immigration policy while trying not to echo Wilders too closely and alienate more progressive voters. The plan singles out the EU’s migration reforms, including its plans to bolster deportations, as a “first big step toward gaining more control over who comes to the Netherlands.” The Dutch government will take a leading role in pushing for changes to international refugee law, including by hosting an asylum summit, according to the program.  But the text also states that the Netherlands will take a stance in EU talks about return and transit hubs to make sure that migrants are never sent to countries where they risk persecution, and put on hold a controversial deal with Uganda to use the African country as a transit point for rejected asylum seekers. 4. IT’S RETURNING TO BRUSSELS’ EMBRACE  After a Euroskeptic tilt under the last Dutch government, Jetten is bringing the Netherlands back on a Brussels course, arguing for closer cooperation. That applies to defense, with the agreement setting a goal of 40 percent of procurement to be carried out “jointly with European partners,” as well as to migration.  Still, the new government remains loyal to the Netherlands’ reputation as one of the frugals, rejecting eurobonds. “Member states are primarily responsible for their own budgets,” the document reads.  The country will also continue to support Ukraine militarily and financially and push to use Russian frozen assets, according to the agreement.  When it comes to the United States, the program struck a stricter tone, pledging to “speak out when their actions undermine our values and interests, always with an eye to maintaining the relationship and preserving critical security interests.”  5. NONE OF THIS IS EVEN REMOTELY A DONE DEAL Perhaps the most important thing to know is that all of the above should be taken with a massive grain of salt. Over the past weeks, the three coalition parties have made a show of presenting a united front. But internal cohesion is by no means a guarantee of success.  In Dutch parliament, the three parties combined only have 66 out of 150 seats. In the Netherlands’ upper chamber they hold 22 out of 75 seats.  That means that the coalition will need to seek external support for every separate issue. Considering that the two largest opposition parties — the leftist GreenLeft-Labor alliance (GL-PvdA) and far-right Party for Freedom (PVV) — hold diametrically opposed views, that is a recipe for political acrobatics. In Jetten’s words: “This will be a cooperation government.”  In practice, Leiden University’s de Lange said, the framework laid out in the coalition agreement already hints the government will have to swerve even further to the right. “When you look at the plans that are on the table right now as a whole, it looks more likely that the decisive support will come from the far right,” de Lange said. “GL-PvdA has said from the beginning that they would not agree with funding defense by cutting social spending.” WHAT’S NEXT?  The Dutch parliament is expected to discuss the coalition agreement on Tuesday. That will be a first bellwether of the mood within various opposition parties and their willingness to help Jetten make good on his promise of getting things done. The divvying up of ministries and Cabinet posts is the next big step. If all goes well, the final team will line up on the steps of the Dutch king’s palace for the traditional photo by late February.  And then the work can begin.

Its been a bad stretch of polling for President Donald Trump. In recent weeks, a string of new polls has found Trump losing ground with key constituencies, especially the young, non-white and low-propensity voters who swung decisively in his direction in 2024. The uptick in support for Trump among those non-traditional Republican voters helped fuel chatter of an enduring “realignment” in the American electorate — but the durability of that realignment is now coming into doubt with those same groups cooling on Trump. Surveying the findings of the most recent New York Times-Siena poll, polling analyst Nate Cohn bluntly declared that “the second Trump coalition has unraveled.” Is it time to touch up the obituaries for the Trumpian realignment? To find out, I spoke with conservative pollster and strategist Patrick Ruffini, whose 2024 book “Party of the People” was widely credited with predicting the contours of Trump’s electoral realignment. Ruffini cautioned against prematurely eulogizing the GOP’s new coalition, noting that the erosion of support has so far not extended to the constituencies that have served as the primary drivers of the Trumpian realignment — particularly white working-class voters and working-class Latinos and Asian Americans. But he also acknowledged that the findings of the recent polls should raise alarms for Republicans ahead of 2026 and especially 2028. His advice to Trump for reversing the trend: a relentless focus on “affordability,” which the White House has so far struggled to muster, and which remains the key issue dragging down the president. “I think that is undeniable,” he said. “It’s the number one issue among the swing voter electorate.” This conversation has been edited for length and clarity. Based on your own polling, do you agree that “the second Trump coalition has unraveled?” It really depends on how you define the Trump coalition. The coalition that has really reshaped American politics over the last decade has been a coalition that saw voters who are aligned with a more populist view of America come into the Republican Party — in many cases, after voting for Barack Obama twice. Those shifts have proven to be pretty durable, especially among white working-class voters but also among conservative Hispanic voters and conservative Asian American voters. You have another group of voters who is younger and disconnected from politics — a group that had been really one of the core groups for Barack Obama and the Democrats back in the 2010s. They didn’t always vote, but there was really no hope or prospect for Republicans winning that group or being very competitive with that group. That happens for the first time in 2024, when that specific combination of young, minority, male voters really comes into play in a big way. But that shift right has proven to be a little bit less durable — and maybe a lot less durable — because of the nature of who those voters are. They’re not really connected to one political party, and they’re inherently non-partisan. So what you’re seeing is less of a shift among people who reliably vote in midterms, and what we are seeing is more of a shift among those infrequent voters. The question then becomes are these voters going to show up in 2026? How big of a problem is it for Republicans if they don’t? How alarmed should Republicans be by the current trends? I think they’re right to focus on affordability. You’ve seen that as an intentional effort by the White House, including what seems like embracing some Democratic policy proposals that also are in some ways an end-run around traditional Republican and conservative economics — things like a 10 percent cap on credit card interest. What’s the evidence that cost of living is the thing that’s primarily eroding Republican support among that group of voters you described? I think that is undeniable. It’s the number one issue among the swing voter electorate. However you want to define the swing voter electorate in 2024, cost of living was far and away the number one issue among the Biden-to-Trump voters in 2024. It is still the number one issue. And that’s because of demographically who they are. The profile of the voter who swung in ‘24 was not just minority, but young, low-income, who tends to be less college-educated, less married and more exposed to affordability concerns. So I think that’s obviously their north star right now. The core Democratic voter is concerned about the erosion of norms and democracy. The core Republican voter is concerned about immigration and border security. But this swing vote is very, very much concerned about the cost of living. Is there any evidence that things like Trump’s immigration crackdown or his foreign policy adventurism are contributing at all to the erosion of support among this group? I have to laugh at the idea of foreign policy being decisive for a large segment of voters. I think you could probably say that, to the extent that Trump had some non-intervention rhetoric, there might be some backlash among some of the podcast bros, or among the Tucker Carlson universe. But that is practically a non-entity when it comes to the actual electorate and especially this group that is floating between the two political parties. Maybe there’s a dissident faction on the right that is particularly focused on this, but what really matters is this cost-of-living issue, which people don’t view as having been solved by Trump coming into office. The White House would say — and Vance said recently — that it takes a while to turn the Titanic around. Which is not the most reassuring metaphor, but sure. Exactly, but nonetheless. I think a lot of these things are very interesting bait for media, but they are not necessarily what is really driving the voters who are disconnected from these narratives. What about his immigration agenda? Does that seem to be having any specific effect? I do think there’s probably some aspect of this that might be challenging with Latinos, but I think it’s very easy to fall back into the 2010 pattern of saying Latino voters are inordinately primarily focused on immigration, which has proven incorrect time after time after time. So, yes, I would say the ICE actions are probably a bit negative, but I think Latino voters primarily share the same concerns as other voters in the electorate. They’re primarily focused on cost of living, jobs and health care. How would Trump’s first year in office have looked different if he had been really laser-focused on consolidating the gains that Republicans saw among these voters in 2024? What would he have done that he didn’t do, and what shouldn’t he have done that he did do? I would first concede that the focus on affordability needed to be, like, a Day 1 concern. I will also concede how hard it is to move this group that is very, very disaffected from traditional politics and doesn’t trust or believe the promises made by politicians — even one as seemingly authentic as Trump. I go back to 2018. While in some ways you would kill for the economic perceptions that you had in 2018, that didn’t seem to help them much in the midterms. The other problem with a laser focus on affordability on Day 1 is that I don’t think it clearly aligns with what the policy demanders on the right are actually asking for. If you ask, “What is MAGA economic policy?”, for many, MAGA economic policy is tariffs — and in many ways, tariffs run up against an impulse to do something about affordability. Now, to date, we haven’t really seen that actually play out. We haven’t really seen an increase in the inflation rate, which is good. But there’s an opportunity cost to focusing on certain issues over this focus on affordability. I think the challenge is that I don’t think either party has a pre-baked agenda that is all about reducing costs. They certainly had a pre-baked agenda around immigration, and they do have a pre-baked agenda around tariffs. What else has stopped the administration from effectively consolidating this part of the 2024 coalition? It’s a very hard-to-reach group. In 2024, Trump’s team had the insight to really put him front-and-center in these non-political arenas, whether it was going to UFC matches or appearing on Joe Rogan. I think it’s very easy for any administration to come into office and pivot towards the policy demanders on the right, and I think that we’ve seen a pivot in that direction, at least on the policy. So I would say they should be doing more of that 2024 strategy of actually going into spaces where non-political voters live and talking to them. Is it possible to turn negative perception around among this group? Or is it a one-way ratchet, where once you’ve lost their support, it’s very hard to get it back? I don’t think it’s impossible. We are seeing some improvement in the economic perception numbers, but we also saw how hard it is to sustain that. I think the mindset of the average voter is just that they’re in a far different place post-Covid than they were pre-Covid. There’s just been a huge negative bias in the economy since Covid, so I think any thought that, “Oh, it would be easy that Trump gets elected, and that’s going to be the thing that restores optimism” was wrong. I think he’s taken really decisive action, and he has solved a lot of problems, but the big nut to crack is, How do you break people out of this post-Covid economic pessimism? The more critical case that could be made against Trump’s approach to economic policy is not just that he’s failed to address the cost-of-living crisis, but that he’s actively done things that run contrary to any stated vision of economic populism. The tax cuts are the major one, which included some populist components tacked on, but which was essentially a massively regressive tax cut. Do you think that has contributed to the sour feeling among this cohort at all? I think we know very clearly when red lines are crossed and when different policies really get voters writ large to sit up and take notice. For instance, it was only when you had SNAP benefits really being cut off that Congress had any impetus to actually solve the shutdown. I don’t think people are quite as tuned in to the distributional effects of tax policy. The White House would say that there were very popular parts of this proposal, like the Trump accounts and no tax on tips, that didn’t get coverage — and our polling has shown that people have barely actually heard about those things compared to some of the Democratic lines of attack. So I think that the tax policy debate is relatively overrated, because it simply doesn’t matter as much to voters as much as the cultural issues or the general sense that life is not as affordable as it was. Assuming these trends continue and this cohort of sort of young, low-propensity voters continues to shift away from Trump, what does the picture look like for Republicans in 2026 and 2028? I would say 2026 is perhaps a false indicator. In the midterms, you’re really talking about an electorate that is going to be much older, much whiter, much more college-educated. I think you really have to have a presidential campaign to test how these voters are going to behave. And presidential campaigns are also a choice between Republicans and Democrats. I think certainly Republicans would want to make it into a Republican-versus-Democrat choice, because polling is very clear that voters do not trust the Democrats either on these issues. It’s clear that a lot of these voters have actually moved away from the Democratic Party — they just haven’t necessarily moved into the Republican Party. Thinking big picture, does this erosion of support change or alter your view of the “realignment” in any respect? I’ve always said that we are headed towards a future where these groups are up for grabs, and whichever party captures them has the advantage. That’s different from the politics of the Obama era, where we were talking about an emerging Democratic majority driven by a generational shift and by the rise of non-white voters in the electorate. The most recent New York Times poll has Democrats ahead among Latino voters by 16 points, which is certainly different than 2024, when Trump lost them by just single digits, but that is a far cry from where we were in 2016 and 2018. So I think in many respects, that version of it is coming true. But if 2024 was a best-case scenario for the right, and 2026 is a worst-case scenario, we really have to wait till 2028 to see where this all shakes out.