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.

China’s foreign ministry on Wednesday said a new European Commission proposal to restrict high-risk tech vendors from critical supply chains amounted to “blatant protectionism,” warning European officials that Beijing will take “necessary measures” to protect Chinese firms. Beijing has “serious concerns” over the bill, Chinese foreign ministry spokesperson Guo Jiakun told reporters, according to state news agencies’ reports. “Using non-technical standards to forcibly restrict or even prohibit companies from participating in the market, without any factual evidence, seriously violates market principles and fair competition rules,” Guo said. The European Commission on Tuesday unveiled its proposal to revamp the bloc’s Cybersecurity Act. The bill seeks to crack down on risky technology vendors in critical supply chains ranging across energy, transport, health care and other sectors. Though the legislation itself does not name any specific countries or companies, it is widely seen as being targeted at China. 5G suppliers Huawei and ZTE are in the EU’s immediate crosshairs, while other Chinese vendors are expected to be hit at a later stage. European Commission spokesperson Thomas Regnier responded to the Chinese foreign ministry, saying Europe has allowed high-risk vendors from outside the EU in strategic sectors for “far too long.” “We are indeed radically changing this. Because we cannot be naive anymore,” Regnier said in a statement. The exclusion of high-risk suppliers will always be based on “strong risk assessments” and in coordination with EU member countries, he said. China “urges the EU to avoid going further down the wrong path of protectionism,” the Chinese foreign ministry’s Guo told reporters. He added the EU bill would “not only fail to achieve so-called security but will also incur huge costs,” saying some restrictions on using Huawei had already “caused enormous economic losses” in Europe in past years. European telecom operators warned Tuesday that the law would impose multi-billion euro costs on the industry if restrictions on using Huawei and ZTE were to become mandatory across Europe. A Huawei spokesperson said in a statement that laws to block suppliers based on their country of origin violate the EU’s “basic legal principles of fairness, non-discrimination, and proportionality,” as well as its World Trade Organization obligations. The company “reserve[s] all rights to safeguard our legitimate interests,” the spokesperson said. ZTE did not respond to requests for comment on the EU’s plans.

The German government rejected claims by U.S. Health Secretary Robert F. Kennedy Jr. that Berlin prosecuted doctors and patients for refusing Covid-19 vaccinations or mask mandates. “The statements made by the U.S. Secretary of Health are completely unfounded, factually incorrect, and must be rejected,” German Health Minister Nina Warken said in a statement late Saturday. “I can happily explain this to him personally,” she said. “At no time during the coronavirus pandemic was there any obligation for doctors to carry out vaccines against Covid-19,” Warken added. “Anyone who did not wish to offer vaccines for medical, ethical or personal reasons were not criminally liable and did not have to fear penalties,” she said. Warken added that “criminal prosecution took place only in cases of fraud and forgery of documents, such as the issuing of false vaccine certificates” or exemption certificates for masks.  “Doctors [in Germany] decide independently and autonomously on the treatment of patients,” the minister stressed, adding that “patients are also free to decide which treatment they wish to receive.” Kennedy said in a video post on Saturday that he had written to Warken after receiving reports that Germany was restricting “people’s abilities to act on their own convictions” in medical decisions. He claimed that “more than a thousand German physicians and thousands of their patients” faced prosecution for issuing exemptions from mask-wearing or Covid-19 vaccination requirements during the pandemic. Kennedy did not provide specific examples or identify the reports he cited, but he said Germany was “targeting physicians who put their patients first” and was “punishing citizens for making their own medical choices.” He accused Berlin of undermining the doctor–patient relationship and replacing it with “a dangerous system that makes physicians enforcers of state policies.” Former German Health Minister Karl Lauterbach also pushed back on the claims, telling Kennedy on X to “take care of health problems in his own country.”

BRUSSELS — If European governments didn’t realize before that Donald Trump’s threats to seize Greenland were serious, they do now. Policymakers are no longer ignoring the U.S. president’s ramped-up rhetoric — and are desperately searching for a plan to stop him. “We must be ready for a direct confrontation with Trump,” said an EU diplomat briefed on ongoing discussions. “He is in an aggressive mode, and we need to be geared up.” U.S. Secretary of State Marco Rubio said Wednesday that he planned to discuss a U.S. acquisition of Greenland with Danish officials next week. The White House said Trump’s preference would be to acquire the territory through a negotiation and also that it would consider purchasing the island — but that a military takeover was possible. As diplomatic efforts intensified in Europe, French Foreign Minister Jean-Noël Barrot said he and his counterparts from Germany and Poland had discussed a joint European response to Trump’s threats. “What is at stake is the question of how Europe, the EU, can be strengthened to deter threats, attempts on its security and interests,” Barrot told reporters. “Greenland is not for sale, and it is not for taking … so the threats must stop.” POLITICO spoke with officials, diplomats, experts and NATO insiders to map out how Europe could deter the U.S. president from getting that far, and what its options are if he does. They were granted anonymity to speak freely. “Everyone is very stunned and unaware of what we actually have in the toolbox,” said a former Danish MP. “No one really knows what to do because the Americans can do whatever they want. But we need answers to these questions immediately. They can’t wait three or five or seven years.” On Wednesday, POLITICO set out the steps Trump could take to seize Greenland. Now here’s the flip side: What Europe does to stop him. OPTION 1: FIND A COMPROMISE Trump says Greenland is vital for U.S. security interests and accuses Denmark of not doing enough to protect it against increasing Chinese and Russian military activity in the Arctic.  A negotiated settlement that sees Trump come out of talks with something he can sell as a win and that allows Denmark and Greenland to save face is perhaps the fastest route out of trouble. A former senior NATO official suggested the alliance could mediate between Greenland, Denmark and the U.S., as it has done with alliance members Turkey and Greece over their disputes. U.S. NATO Ambassador Matthew Whitaker said on Wednesday that Trump and his advisers do not believe Greenland is properly secured. | Omar Havana/Getty Images U.S. NATO Ambassador Matthew Whitaker said on Wednesday that Trump and his advisers do not believe Greenland is properly secured. “As the ice thaws and as the routes in the Arctic and the High North open up … Greenland becomes a very serious security risk for the mainland of the United States of America.” NATO allies are also mulling fresh overtures to Trump that could bolster Greenland’s security, despite a widely held view that any direct threat from Russian and Chinese ships to the territory is overstated. Among other proposals, the alliance should consider accelerating defense spending on the Arctic, holding more military exercises in the region, and posting troops to secure Greenland and reassure the U.S. if necessary, according to three NATO diplomats.  The alliance should also be open to setting up an “Arctic Sentry” scheme — shifting its military assets to the region — similar to its Eastern Sentry and Baltic Sentry initiatives, two of the diplomats said. “Anything that can be done” to bolster the alliance’s presence near Greenland and meet Trump’s demands “should be maxed out,” said one of the NATO diplomats cited above. Trump also says he wants Greenland for its vast mineral deposits and potential oil and gas reserves. But there’s a reason Greenland has remained largely untapped: Extracting resources from its inhospitable terrain is difficult and very expensive, making them less competitive than Chinese imports. Denmark’s envoys say they tried for years to make the case for investment in Greenland, but their European counterparts weren’t receptive — though an EU diplomat familiar with the matter said there are signs that attitude is shifting. OPTION 2: GIVE GREENLAND A TON OF CASH The Trump administration has thrown its weight behind Greenland’s independence movement. The pitch is that if the Arctic territory leaves the Kingdom of Denmark and signs up to a deal with the U.S., it will be flooded with American cash.  While Trump has repeatedly refused to rule out using military force to take Greenland, he has also insisted he wants it to come willingly. The EU and Denmark are trying to convince Greenlanders that they can give them a better deal. Brussels is planning to more than double its spending on Greenland from 2028 under long-term budget plans drawn up after Trump started to make claims on the Danish-held territory, according to a draft proposal from the European Commission published in September. Under the plans, which are subject to further negotiations among member countries, the EU would almost double spending on Greenland to €530 million for a seven-year period starting in 2028.  That comes on top of the money Denmark sends Greenland as part of its agreement with the self-governing territory. Greenland would also be eligible to apply for an additional €44 million in EU funding for remote territories associated with European countries, per the same document. Danish and European support currently focuses mainly on welfare, health care, education and the territory’s green transition. Under the new spending plans, that focus would expand to developing the island’s ability to extract mineral resources. “We have many, many people below the poverty line, and the infrastructure in Greenland is lagging, and our resources are primarily taken out without good profit to Greenland but mostly profit to Danish companies,” said Kuno Fencker, a pro-independence Greenlandic opposition MP.  An attractive offer from Denmark and the EU could be enough to keep Greenlanders out of America’s grasp. OPTION 3: RETALIATE ECONOMICALLY Since Trump’s first term in office, “there’s been a lot of effort to try and think through how we ensure European security, Nordic security, Arctic security, without the U.S. actively involved,” said Thomas Crosbie, a U.S. military expert at the Royal Danish Defense College, which provides training and education for the Danish defense force. “That’s hard, but it’s possible. But I don’t know if anyone has seriously contemplated ensuring European security against America. It’s just crazy,” Crosbie said. The EU does have one strong political tool at its disposal, which it could use to deter Trump: the Anti-Coercion Instrument, the “trade bazooka” created after the first Trump administration, which allows the EU to retaliate against trade discrimination. The EU threatened to deploy it after Trump slapped tariffs on the bloc but shelved it in July after the two sides reached a deal. With the U.S. still imposing tariffs on the EU, Brussels could bring the bazooka back out. “We have exports to the United States a bit above €600 billion, and for around one-third of those goods we have a market share of more than 50 percent and it’s totally clear that this is also the power in our hands,” said Bernd Lange, chair of the European Parliament’s trade committee. But Trump would have to believe the EU was serious, given that all its tough talk amounted to nothing the last time around. OPTION 4: BOOTS ON THE GROUND If the U.S. does decide to take Greenland by military force, there’s little Europeans could do to prevent it.  “They are not going to preemptively attack Americans before they claim Greenland, because that would be done before an act of war,” said Crosbie, the Danish military educator. “But in terms of responding to the first move, it really depends. If the Americans have a very small group of people, you could try and arrest those people, because there’d be a criminal act.” It’s a different story if the U.S. goes in hard. Legally speaking, it’s possible Denmark would be forced to respond militarily. Under a 1952 standing order, troops should “immediately take up the fight without waiting for, or seeking orders” in “the event of an attack on Danish territory.” European countries should weigh the possibility of deploying troops to Greenland — if Denmark requests it — to increase the potential cost of U.S. military action, an EU diplomat said, echoing suggestions that Berlin and Paris could send forces to deter any incursion. While those forces are unlikely to be able to withstand a U.S. invasion, they would act as a deterrent. “You could have a tripwire effect where you have some groups of people who are physically in the way, like a Tiananmen Square-type situation, which would potentially force the [U.S.] military to use violence” or to back down, said Crosbie.  But that strategy comes at a high cost, he said. “This is completely unexplored territory, but it is quite possible that people’s lives will be lost in the attempt to reject the American claim over Greenland.” Gerardo Fortuna, Clea Caulcutt and Eli Stokols contributed reporting.

LONDON — They’re young, full of ideas — and about to be given the vote. Britain’s government has committed to lowering the voting age from 18 to 16 years — a major extension of the electorate that could have big implications for the outcome of the next race, expected by 2029. It means Brits who are just 12 today are in line to vote in the next general election, which is expected to be a fierce battle between incumbent Keir Starmer and his right-wing challenger Nigel Farage. But what do these young people actually think? In a bid to start pinning down the views of this cohort, POLITICO commissioned pollster More in Common to hold an in-depth focus group, grilling eight youngsters from across the country on everything from social media disinformation to what they would do inside No. 10 Downing Street. To protect those taking part in the study, all names used below are pseudonymous. The group all showed an interest in politics, and had strong views on major topics such as immigration and climate change — but the majority were unaware they would get the chance to vote in 2029.  In a bid to prepare the country for the change, the Electoral Commission has recommended that the school curriculum be reformed to ensure compulsory teaching on democracy and government from an early age. GET YOUR ACT TOGETHER There are few better introductions to the weird world of British politics than prime minister’s questions, the weekly House of Commons clash between Prime Minister Keir Starmer and his Conservative opponent Kemi Badenoch. Our group of 12-13-year-olds was shown a clip of the clash and asked to rate what they saw. They came away distinctly unimpressed. Hanh, 13, from Surrey, said the pair seemed like children winding each other up. “It seems really disrespectful in how they’re talking to each other,” she commented. “It sounds like they’re actually kids bickering … They were just going at each other, which didn’t seem very professional in my opinion.” Sarah, 13, from Trowbridge in the west of England, said the leading politicians were “acting like a pack of wild animals.” | Clive Brunskill/Getty Images Sarah, 13, from Trowbridge in the west of England, said the leading politicians were “acting like a pack of wild animals.” In the clip, the Commons backbenches roar as Tory Leader Kemi Badenoch quips about Starmer’s MPs wanting a new leader for Christmas. In turn, the PM dismisses the Conservative chief’s performance as a “Muppet’s Christmas Carol.” Twelve-year-old Holly, from Lincolnshire, said the pair were being “really aggressive and really harsh on each other, which was definitely rude.” And she said of the PM: “It weren’t really working out for Keir Starmer.” None of the children knew who Badenoch was, but all knew Starmer — even if they didn’t have particularly high opinions of the prime minister, who is tanking in the polls and struggling to get his administration off the ground. Twelve-year-old Alex said the “promises” Starmer had made were just “lies” to get him into No. 10. Sophie, a 12-year-old from Worcester in the West Midlands, was equally withering, saying she thought the PM is doing a “bad job.” “He keeps making all these promises, but he’s probably not even doing any of them,” she added. “He just wants to show off and try to be cool, but he’s not being cool because he’s breaking all the promises. He just wants all the money and the job to make him look really good.” Sarah said: “I think that it’s quite hard to keep all of those promises, and he’s definitely bitten off more than he can chew with the fact that he’s only made those statements because he wants to be voted for and he wants to be in charge.”  While some of the young people referenced broken promises by Starmer, none offered specifics. THE FARAGE FACTOR Although they didn’t know Badenoch as leader of the opposition, the whole room nodded when asked if they knew who Nigel Farage was. Although they didn’t know Badenoch as leader of the opposition, the whole room nodded when asked if they knew who Nigel Farage was. | Dan Kitwood/Getty Images “He’s the leader of the Reform party,” said Alex, whose favorite subject is computing. “He promises lots of things and the opposite of what Starmer wants. Instead of helping immigrants, he wants to kick them out. He wants to lower taxes, wants to stop benefits.” Alex added: “I like him.” Sarah was much less taken. “I’ve heard that he’s the leader of the far right, or he’s part of the far right. I think he’s quite a racist man.” Farage has faced accusations in recent weeks of making racist remarks in his school days. The Reform UK leader replied that he had “never directly racially abused anybody.” Other participants said they’d only heard Farage’s name before. When asked who they would back if they were voting tomorrow, most children shrugged and looked bewildered. Only two of the group could name who they wanted to vote for — both Alex and Sam backed Farage. POLICY WORRIES Politicians have long tried to reach Britain’s youngsters through questionable TikTok videos and cringe memes — but there was much more going on in the minds of this group than simply staring at phones. Climate change, mental health and homelessness were dominant themes of the conversation. Climate change is “dangerous because the polar bears will die,” warned Chris, 13, from Manchester. Sophie, who enjoys horse riding, is worried about habitats being destroyed and animals having to find new homes as a result of climate change, while Sarah is concerned about rising sea levels. Thirteen-year-old Ravi from Liverpool said his main focus was homelessness. “I know [the government is] building houses, but maybe speed the process up and get homeless people off the streets as quick as they can because it’s not nice seeing them on the streets begging,” he said. Sam agreed, saying if he personally made it into No.10, he would make sure “everyone has food, water, all basic survival stuff.” Sarah’s main ask was for better mental health care amid a strained National Health Service. “The NHS is quite busy dealing with mental health, anxiety and things like that,” she said. “Maybe we should try and make an improvement with that so everyone gets a voice and everyone’s heard.” IMMIGRATION DIVISIONS When the conversation moved to the hot-button topic of immigration, views were more sharply divided. Imagining what he’d do in government, Alex said he’d focus on “lowering taxes and stopping illegal immigrants from coming over.” “Because we’re paying France billions just to stop them, but they’re not doing anything,” he said. “And also it’s spending all the tax money on them to give them home meals, stuff like that.” In July, Starmer and France’s Emmanuel Macron unveiled a “one in, one out” pilot program to tackle illegal migration, although it’s enjoyed limited success so far and has generated some embarrassing headlines for the British government. Hanh said she’d been taught at school that it’s important to show empathy, but noted some people are angry about taxes going to support asylum seekers. Chris and Sarah both said asylum seekers are fleeing war, and seemed uneasy at the thought of drawing a hard line. Holly said she wants “racism” — which she believes is tied to conversations about immigration — to end. “I often hear a lot of racism [at school] and prejudice-type stuff … I often hear the N word. People don’t understand how bad that word is and how it can affect people,” she said. “They [migrants] have moved away from something to get safer, and then they get more hate.” Hanh said she is seeing more anti-immigration messages on social media, such as “why are you in my country, get out,” she said. “Then that’s being dragged into school by students who are seeing this … it’s coming into school environment, which is not good for learning.” NEWS SNOOZE Look away now, journalists: The group largely agreed that the news is boring. Some listen in when their parents have the television or radio on, but all said they get most of their news from social media or the odd push alert. Asked why they think the news is so dull, Hanh — who plays field hockey and enjoys art at school — said: “It just looks really boring to look at, there are no cool pictures or any funny things or fun colors. It just doesn’t look like something I’d be interested in.” She said she prefers social media: “With TikTok, you can interact with stuff and look at comments and see other people’s views, [but with the news] you just see evidence and you see all these facts. Sometimes it can be about really disturbing stuff like murder and stuff like that. If it’s going to pop up with that, I don’t really want to watch that.” These children aren’t alone in pointing to social media as their preferred source of news. A 2025 report by communications watchdog Ofcom found that 57 percent of 12-15-year-olds consume news on social media, with TikTok being the most commonly used platform, followed by YouTube and then Instagram. Sophie isn’t convinced that the news is for her. “Sometimes if my parents put it on the TV and it’s about something that’s really bad that’s happened, then I’ll definitely look at it,” she said. “But otherwise, I think it would probably be more for older people because they would like to watch basically whatever’s on the TV because they can’t really be bothered to change the channel.”

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

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