Musk’s woes deepen as Tesla strike spreads across Scandinavia


Sweden v. Musk

The labour dispute between Tesla and its repair workshop mechanics that originated in Sweden on October 27 has escalated to include Denmark, Finland and Norway. As the stakes rise, Elon Musk’s electric vehicle manufacturer continues to resist signing a collective agreement with its Swedish employees.

Tesla majority-shareholder and CEO Elon Musk faces growing resistance in Scandinavia’s social democracies after refusing to sign a collective agreement determining the minimum wage of his employees.

The dispute, which initially involved only 130 mechanics at ten Tesla repair workshops across seven Swedish cities, has ballooned into an international strike movement.

“The mistake [American multinational] Tesla made was challenging the collective agreements that set sector-specific minimum wages in Sweden, a country where 70% of the population is unionised, compared with only 8% of private sector workers in France,” says Yohann Aucante, a political scientist and Scandinavia specialist at the School for Advanced Studies in the Social Sciences (EHESS) in Paris.

Concerned about safeguarding collective agreements, which cover nearly 90% of all employees in Sweden, 15 Swedish unions have joined the strike at the request of the powerful IF Metall union since it kicked off on October 27.

Transporters are refusing to deliver vehicles while electricians are declining to repair charging stations. Cleaning staff have stopped cleaning showrooms, garbage is piling up outside Tesla centres as refuse collectors refuse to pick it up, and the Swedish postal service has stopped delivering license plates essential for registering new Teslas.

On the retail end of the supply chain, car dealerships have stopped offering Teslas and Stockholm taxis have suspended their Tesla purchases.

Neighbours join fight

Far from stopping in Sweden, the “sympathy strike” has spread to the country’s Nordic cousins who also see Tesla’s ambitions as threatening their labour models.

“There are also strong collective agreements and unions in Norway, especially in Denmark, where these agreements determine the majority of labour law,” says Aucante. “Therefore, Norwegians and Danes are keen on this model which gives unions some negotiating power against employers.”

After Denmark’s largest union, 3F, declared a solidarity strike with Swedish workers on December 5, Norway’s largest private sector union warned on December 6 that it would block the transit of Tesla cars to Sweden if the American automaker did not reach an agreement with its Swedish workers by December 20.

The following day, the Finnish transport workers’ union AKT offered the same pledge. “It is a crucial part of the Nordic labour market model that we have collective agreements and unions support each other,” AKT president Ismo Kokko said in a statement.

International sympathy strikes are rare, but not unprecedented says Aucante. The last major mobilisation dates back to 1995 when the American toy company Toys “R” Us tried to bypass unions and impose its own salary rules. The retailer eventually yielded after three months of strikes in Sweden and Europe. 

Musk outraged

The revolt has provoked outrage from Musk who described the industrial action as “insane” on his social network, X, on November 23.

In response, Tesla filed a request to compel the Swedish postal operator to deliver the license plates and sought compensation for a loss of over €87,000. However, its prosecution request was rejected on December 7 by a Swedish court.

The carmaker is now actively seeking a government affairs specialist in Sweden to help resolve the issue. A job listing posted recently on the Tesla careers website shows the company is looking for someone with a “proven track record of getting regulatory changes made in the Nordics”.

Nordic investors ‘deeply concerned’

Another, more serious threat to Musk is a group of powerful pension funds in the region which have begun criticising Tesla’s conduct.

A group of Nordic investors, which include Norway‘s largest pension fund KLP, Sweden’s Folksam and Denmark‘s PFA, defended the Swedish labour market model in a letter sent to Tesla on Thursday, saying they are “deeply concerned” about the situation.

“We as Nordic investors acknowledge the decade-old tradition of collective bargaining, and therefore urge Tesla to reconsider your current approach to unions,” the letter reads.

The investor letter also asks for a meeting with Tesla’s board in early 2024 to discuss the matter.

Some funds, acting individually, have gone further in their critique. Kiran Aziz, head of responsible investments at KLP, which holds around €195 million in Tesla shares, said it’s not “just about the labour model in the Nordic but about fundamental human rights”.

Read moreMacron, Musk meet in Paris to discuss future investment in France

In Denmark, the pension fund PensionDanmark has decided it’s already seen enough. It sold its 476 million Danish crowns (€64 million) in Tesla holdings on December 7.

The Norges Bank Investment Bank (NBIM), which operates the Norwegian sovereign wealth fund and is the seventh-largest Tesla shareholder with a stake of around €6.3 billion, did not sign on to the letter. However, it declared last week that it would continue to pressure the company to respect labour rights, such as collective bargaining.

A blow to branding

For Tesla, the stakes are high. “As Scandinavians are the leading consumers of Tesla in Europe, the company has no interest in prolonging a conflict that will severely damage its image,” says Aucante, who believes Tesla will have to make concessions.

“With the trend towards greening economies, it’s ‘bad form’ to produce cars in China when building an electric car aimed at reducing carbon impact,” adds Aucante. “That’s why Tesla is trying to bring back some of its production to Europe, but labour costs are not the same, and there are more regulations here.”

While the strike currently affects only northern European countries, there is speculation it could inspire the 11,000 employees at Tesla’s largest European operation, the Gigafactory Berlin-Brandenburg.

German employees secured a 4% salary increase in early November as a result of pressure from German unions – a concession which could be linked to the fear of the strike in Nordic countries migrating south, according to the Washington Post.

Across the Atlantic, Tesla workers have yet to unionise. However, after the United Auto Workers (UAW) successfully negotiated deals with Ford, General Motors and Stellantis in November, Tesla is likely worried about unions back home, too.

This article was translated from the original in French.

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The right to breathe: how policymakers can tackle severe asthma

Asthma impacts over 330 million people worldwide. While severe asthma makes up only 5-10 percent of cases, it is accountable for over half of asthma-related costs globally.[1] It profoundly affects patients’ lives, undermining their physical, mental and economic well-being, and increasing the risk of preventable deaths. Despite its significance, severe asthma is often overshadowed by other health priorities, leading to inadequate resource allocation and substandard care, further straining already pressured health systems.

Severe asthma outcomes, like many other chronic diseases, are deeply entangled with a wide range of environmental and socio-economic factors. Therefore, addressing it is not merely about medical intervention, but about creating and implementing comprehensive, holistic strategies.

The challenges presented by severe asthma are not beyond our capabilities. Around the globe, there is a wide range of best practices, treatments, and approaches to asthma management. Yet, the path to transformation demands a unified commitment from a broad set of stakeholders, from policymakers to medical professionals, industry, patients and beyond. While the blueprint for a future unburdened by severe asthma exists, it is up to decision-makers to realize it together.

While the blueprint for a future unburdened by severe asthma exists, it is up to decision-makers to realize it together.

And the good news is that progress is already underway. Since autumn 2022, we have collaborated as an international expert group to support the development of the Copenhagen Institute for Futures Studies’ (CIFS) Severe Asthma Index. This tool assesses how 29 OECD countries manage severe asthma across various indicators, such as national strategies, treatment access, hospitalizations, societal costs and air quality, among others.

While the Severe Asthma Index is an important stride in tackling severe asthma, the true test lies in how its insights are applied in practice. Among the many actions needed to be taken to improve severe asthma care, the most pressing concern is policy change.

We have identified three actions, derived from the work we have conducted to date, for policymakers to kickstart strengthening health systems’ approaches to and management of severe asthma:

  1. Development and implementation of national asthma plans and strategies

The Severe Asthma Index has found that less than half of the countries analyzed have a national strategy for asthma, prevention, and management. There is, therefore, a need to formulate and actively implement dedicated national asthma programs, tailored to the unique challenges of individual health systems. These programs should not only emphasize prevention, early detection and diagnosis but also adapt best practices to specific national and local contexts.

Importantly, plans should be situated in the context of long-term strategies for improving population health outcomes.

“In England, work around respiratory illness is gaining traction,” notes Sir David Behan, chair of Health Education England, NHS, and expert group member. “Part of the initiative being developed [is] to ease pressure on the emergency care pathways and hospitals.”  

All approaches should promote awareness on respiratory diseases, support personalized care plans, empower patients and improve training and opportunities for training health care professionals working in respiratory care.

2. Coordination and harmonization of policies and care guidelines

There is a patchwork of country approaches to severe asthma, illustrated by the observation that more than two-thirds of the country guidelines assessed in the Severe Asthma Index do not fully align with the Global Initiative for Asthma’s (GINA) guide for Difficult-to-treat and Severe Asthma in Adolescence And Adult Patients. Policymakers must strive to coordinate their approaches to severe asthma by harmonizing policies and guidelines for asthma care to the greatest possible extent, with the aim of reducing outcome disparities, bolstering equity and promoting health system sustainability.

In doing so, there should be an emphasis on identifying and scaling best practices, promoting cross-border collaboration, and championing holistic solutions informed by the widely-acclaimed Health in All Policies approach.

The Australian National Asthma Council’s Australian Asthma Handbook is a strong example of a best practice in this area that policymakers could draw inspiration from in acting on this point.

3. Supporting improved data collection and the development of a more robust evidence base for severe asthma

Policymakers should incentivize and ultimately mandate improved production, recording and utilization of asthma- and severe asthma-specific data, as well as identifier data such as prescription data, adherence to treatment regimes, lung function analysis and demographic and socioeconomic indicators, following a set of common standards.

Currently, despite the existence of clinical codes for severe asthma, the condition remains significantly underreported in clinical settings due in large part to inconsistent coding practices, leading to an increased probability of patients receiving inadequate care and suboptimal allocation of health system resources. The dearth of severe asthma data and barriers to accessing the few datasets that do exist render it difficult to develop a comprehensive and consistent understanding of the full impact of severe asthma.

National policymakers need to prioritize financial and logistical support for country-level asthma research. Research activities should aim to produce a solid evidence base that will offer a nuanced understanding of each country’s needs, challenges and opportunities regarding asthma care. Support for research activities granted over the long term will enable longitudinal studies so that national trends and progress can be accurately tracked.

Only 3 percent of the European Union’s budget for health [is] spent on lung health, although 13 percent of Europeans have lung disease.

“Only 3 percent of the European Union’s budget for health [is] spent on lung health, although 13 percent of Europeans have lung disease,” says Susanna Palkonen, director of the European Federation of Allergy & Airways Diseases Patients’ Associations (EFA) and expert group member.

The International Severe Asthma Registry (ISAR) initiative provides a strong basis for continued work in this area.

The path ahead requires that these actions evolve in tandem with the latest advancements in respiratory care and approaches to the management and prevention of noncommunicable diseases. This is not simply about updating and developing new policies — it’s about crafting robust and well-rounded solutions that proactively address a health challenge that is both global and local and supporting a much-needed vision for improved respiratory health outcomes.

As we look forward, we cannot just treat asthma. We must transform our approach to ensure that every patient’s right to breathe becomes a global reality.


Author(s):
Patrick Henry Gallen, senior advisor and futurist at Copenhagen Institute for Futures Studies

Bogi Eliasen, director of health at Copenhagen Institute for Futures Studies

Professor Dr. Vibeke Backer, MD, DMSci, chief respiratory physician at Department of ENT and Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark

Sir David Behan, chair Health Education England, National Health System (NHS), U.K.​

Dr. Mark Levy, board member, Global Initiative for Asthma (GINA), U.K.​

Mikaela Odemyr, chair European Lung Foundation (ELF) Patient Advisory Committee; chair Swedish Asthma and Allergy Association, Sweden

Susanna Palkonen, director, European Federation of Allergy and Airways Diseases Patients’ Associations (EFA)  

Professor Dr. Arzu Yorgancıoğlu, chair European Respiratory Society (ERS) Advocacy Council; member of Global Initiative on Asthma (GINA) Board; chair of GINA Dissemination and Implementation Committee; chair of the WHO GARD Executive Committee Turkey 


References:
[1] Al Efraij K, FitzGerald JM. Current and emerging treatments for severe asthma. J Thorac Dis 2015;7(11):E522-E525



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Speed is everything for patients: together we can bring medicines faster

Working in our industry brings huge responsibility. We deal with people’s lives, and our  medicines give people an opportunity to improve their health, often at the most overwhelming time for them. I had a strong reminder of that recently.

Last month, I met with a colleague, Heiko, who lives in Germany. His young daughter has central nervous system (CNS) neuroblastoma — a type of cancer that tends to affect children under the age of five.

Heiko and his family have been navigating the health system for months, including an overload of information in the form of complex ‘oncological-speak’, treatment guidelines and health insurance claims. They have also been dealing with constant travel to specialist centers — all while juggling the emotional burden of caring for a sick child and the daily challenges of home and work life.

He shared something that stuck in my mind the night I spoke with him, which serves as an important reminder for all of us working in health care.

“Trust must be bigger than fear.”

When their health is at stake, friends, families and colleagues put their trust in their local health care system — every part of it, including industry — in the hope of protecting the future for them and their loved ones.

As Heiko put it to me, “Speed is everything. If you gain enough speed, you gain enough time. And if you have time, you have the hope of more options that can help you.”

Faster, more equitable access to new, life-saving medicines for people living in Europe is a goal that I believe we all share. There are challenges in achieving this, but we at Roche are committed to addressing these, together with everyone involved.

It is the inequality in access to medicines that is untenable.

Teresa Graham, CEO, Roche Pharmaceuticals, and chair EFPIA’s Patient Access Committee | via EFPIA

The average time that patients in the EU wait to get access to a new medicine is around 517 days. Uptake of new technologies can be low and slow, but it is the inequality in access to medicines that is untenable. If you have cancer in Germany, you may need to wait, on average, 128 days to access a new medicine, but if you are a patient in Romania it will take you 918 days to receive the same treatment.

I am concerned that Europe’s policymakers believe this can be fixed with legislation alone. And, even if it could, families like Heiko’s do not have the luxury of waiting four to five years for the ongoing revision to the EU pharmaceutical legislation to attempt to resolve these issues.

Improving access to medicines requires solutions that are developed in partnership with everyone who has a stake in their delivery: industry, member states, health regulators, payers, patients and health care providers. With the right ambition and desire for collaboration, we can act now.

The crucial first step is for governments and policymakers to treat spending on health care and innovation as an investment in economic growth and societal advancement. Improving health care and expanding access to innovation are vital for reducing pressure on health care systems, maintaining a healthy and productive society, and driving future economic growth.

Governments and policymakers have a pivotal role in enabling and encouraging this cycle of improved health and economic benefit. We must take a strategic view of investing in innovation, acknowledging the wider societal value it provides, and find sustainable ways to manage immediate fiscal challenges that do not limit or delay access to new medicines and technologies.

The industry is also driving changes. One concrete commitment pharmaceutical companies have made is to file new medicines for pricing and reimbursement in all member states within two years of EU approval of a new medicine. This will improve timely access to the latest innovations.

The industry has also established a portal for tracking access delays and ensuring companies are held accountable in meeting the two-year filing commitment.

With the right ambition and desire for collaboration, we can act now.

With multiple ongoing legislative changes currently taking place in Europe — from the revision of the EU’s Pharmaceutical Legislation, to the EU’s reform of Health Technology Assessment (HTA) and the introduction of the European Health Data Space (EHDS) — we have a unique opportunity to build a stronger and better European environment for life sciences and health care that serves patients’ best interests. One major opportunity for collaboration is the implementation of the EU’s HTA regulation. This aims to address access delays by streamlining and accelerating highly fragmented HTA processes across Europe. There is only one year to go before this either becomes a meaningful contributor to faster access decisions for patients or — if not adequately in focus during 2024 — risks becoming an additional hurdle for patient access to essential treatments. In order to avoid this scenario, industry involvement in the implementation of EU HTA is crucial to leverage expertise, co-design relevant processes, and ultimately ensure a workable system.

Such actions can reduce some of the delays in accessing new medicines, but they will not solve everything. The majority of delays come from the variation and delays in individual countries’ reimbursement and health care systems. That is why it is critical that member states, payers and health systems collaborate with industry to develop tailored access solutions. 

However, there are also proposals on the table today that are concerning and at face value will not lead to improved access for patients. For instance, the EU Commission is proposing to reduce a company’s intellectual property rights — specifically regulatory data protection (RDP) — if a medicine is not available in all member states within two years of receiving marketing authorisation. This would only hinder innovation, without delivering faster, more equitable access to new medicines.

If this were to go ahead as proposed, Europe would become a less attractive place for research. A recently-published study on the impact of the European Commission’s proposal estimated that it would reduce Europe’s share of global R&D investment by one-third by 2040.

I firmly believe this proposal must be reconsidered and focused on policy solutions that ensure patients in Europe continue to benefit from innovation.

As Heiko says, speed, time and hope are all people have. Often, patients are waiting for the next innovation, during which time, their disease progresses or their condition deteriorates. This makes the next clinical trial, the next regulatory approval, the next standard of care, the next reimbursement decision absolutely vital for those who simply cannot wait.

Across industry, there are more than 8,000 new medicines in the global pipeline today. This is the hope Heiko needs, and families like his are trusting us all to deliver.

Speaking with Heiko reminded me that the most effective treatment is the one that makes it to the patient when they need it. It is now our collective responsibility to find the path to making this happen for patients everywhere in Europe.



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Israel’s appetite for high-tech weapons highlights a Biden policy gap

Within hours of the Hamas attack on Israel last month, a Silicon Valley drone company called Skydio began receiving emails from the Israeli military. The requests were for the company’s short-range reconnaissance drones — small flying vehicles used by the U.S. Army to navigate obstacles autonomously and produce 3D scans of complex structures like buildings.

The company said yes. In the three weeks since the attack, Skydio has sent more than 100 drones to the Israeli Defense Forces, with more to come, according to Mark Valentine, the Skydio executive in charge of government contracts.

Skydio isn’t the only American tech company fielding orders. Israel’s ferocious campaign to eliminate Hamas from the Gaza Strip is creating new demand for cutting-edge defense technology — often supplied directly by newer, smaller manufacturers, outside the traditional nation-to-nation negotiations for military supplies.

Already, Israel is using self-piloting drones from Shield AI for close-quarters indoor combat and has reportedly requested 200 Switchblade 600 kamikaze drones from another U.S. company, according to DefenseScoop. Jon Gruen, CEO of Fortem Technologies, which supplied Ukrainian forces with radar and autonomous anti-drone aircraft, said he was having “early-stage conversations” with Israelis about whether the company’s AI systems could work in the dense, urban environments in Gaza.

This surge of interest echoes the one driven by the even larger conflict in Ukraine, which has been a proving ground for new AI-powered defense technology — much of it ordered by the Ukrainian government directly from U.S. tech companies.

AI ethicists have raised concerns about the Israeli military’s use of AI-driven technologies to target Palestinians, pointing to reports that the army used AI to strike more than 11,000 targets in Gaza since Hamas militants launched a deadly assault on Israel on Oct 7.

The Israeli defense ministry did not elaborate in response to questions about its use of AI.

These sophisticated platforms also pose a new challenge for the Biden administration. On Nov. 13, the U.S. began implementing a new foreign policy to govern the responsible military use of such technologies. The policy, first unveiled in the Hague in February and endorsed by 45 other countries, is an effort to keep the military use of AI and autonomous systems within the international law of war.

But neither Israel nor Ukraine are signatories, leaving a growing hole in the young effort to keep high-tech weapons operating within agreed-upon lines.

Asked about Israel’s compliance with the U.S.-led declaration on military AI, a spokesperson for the State Department said “it is too early” to draw conclusions about why some countries have not endorsed the document, or to suggest that non-endorsing countries disagree with the declaration or will not adhere to its principles.

Mark Cancian, a senior adviser with the CSIS International Security Program, said in an interview that “it’s very difficult” to coordinate international agreement between nations on the military use of AI for two reasons: “One is that the technology is evolving so quickly that the description constraints you put on it today may no longer may not be relevant five years from now because the technology will be so different. The other thing is that so much of this technology is civilian, that it’s hard to restrict military development without also affecting civilian development.”

In Gaza, drones are being largely used for surveillance, scouting locations and looking for militants without risking soldiers’ lives, according to Israeli and U.S. military technology developers and observers interviewed for this story.

Israel discloses few specifics of how it uses this technology, and some worry the Israeli military is using unreliable AI recommendation systems to identify targets for lethal operations.

Ukrainian forces have used experimental AI systems to identify Russian soldiers, weapons and unit positions from social media and satellite feeds.

Observers say that Israel is a particularly fast-moving theater for new weaponry because it has a technically sophisticated military, large budget, and — crucially — close existing ties to the U.S. tech industry.

“The difference, now maybe more than ever, is the speed at which technology can move and the willingness of suppliers of that technology to deal directly with Israel,” said Arun Seraphin, executive director of the National Defense Industrial Association’s Institute for Emerging Technologies.

Though the weapons trade is subject to scrutiny and regulation, autonomous systems also raise special challenges. Unlike traditional military hardware, buyers are able to reconfigure these smart platforms for their own needs, adding a layer of inscrutability to how these systems are used.

While many of the U.S.-built, AI-enabled drones sent to Israel are not armed and not programmed by the manufacturers to identify specific vehicles or people, these airborne robots are designed to leave room for military customers to run their own custom software, which they often prefer to do, multiple manufacturers told POLITICO.

Shield AI co-founder Brandon Tseng confirmed that users are able to customize the Nova 2 drones that the IDF is using to search for barricaded shooters and civilians in buildings targeted by Hamas fighters.

Matt Mahmoudi, who authored Amnesty International’s May report documenting Israel’s use of facial recognition systems in Palestinian territories, told POLITICO that historically, U.S. technology companies contracting with Israeli defense authorities have had little insight or control over how their products are used by the Israeli government, pointing to several instances of the Israeli military running its own AI software on hardware imported from other countries to closely monitor the movement of Palestinians.

Complicating the issue are the blurred lines between military and non-military technology. In the industry, the term is “dual-use” — a system, like a drone-swarm equipped with computer-vision, that might be used for commercial purposes but could also be deployed in combat.

The Technology Policy Lab at the Center for a New American Security writes that “dual-use technologies are more difficult to regulate at both the national and international levels” and notes that in order for the U.S. to best apply export controls, it “requires complementary commitment from technology-leading allies and partners.”

Exportable military-use AI systems can run the gamut from commercial products to autonomous weapons. Even in cases where AI-enabled systems are explicitly designed as weapons, meaning U.S. authorities are required by law to monitor the transfer of these systems to another country, the State Department only recently adopted policies to monitor civilian harm caused by these weapons, in response to Congressional pressure.

But enforcement is still a question mark: Josh Paul, a former State Department official, wrote that a planned report on the policy’s implementation was canceled because the department wanted to avoid any debate on civilian harm risks in Gaza from U.S. weapons transfers to Israel.

A Skydio spokesperson said the company is currently not aware of any users breaching its code of conduct and would “take appropriate measures” to mitigate the misuse of its drones. A Shield AI spokesperson said the company is confident its products are not being used to violate humanitarian norms in Israel and “would not support” the unethical use of its products.

In response to queries about whether the U.S. government is able to closely monitor high-tech defense platforms sent by smaller companies to Israel or Ukraine, a spokesperson for the U.S. State Department said it was restricted from publicly commenting or confirming the details of commercially licensed defense trade activity.

Some observers point out that the Pentagon derives some benefit from watching new systems tested elsewhere.

“The great value for the United States is we’re getting to field test all this new stuff,” said CSIS’s Cancian — a process that takes much longer in peacetime environments and allows the Pentagon to place its bets on novel technologies with more confidence, he added.



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AWS digital sovereignty pledge: A new, independent sovereign cloud in Europe

From day one, Amazon Web Services (AWS) has believed it is essential that customers have control over their data, and choices for how they secure and manage that data in the cloud. Last year, we introduced the AWS Digital Sovereignty Pledge, our commitment to offering AWS customers the most advanced set of sovereignty controls and features available in the cloud.

AWS offers the largest and most comprehensive cloud infrastructure globally. Our approach from the beginning has been to make AWS sovereign-by-design. We built data protection features and controls in the AWS cloud with input from financial services, health care and government customers — who are among the most security- and data privacy-conscious organizations in the world. This has led to innovations like the AWS Nitro System, which powers all our modern Amazon Elastic Compute Cloud (Amazon EC2) instances and provides a strong physical and logical security boundary to enforce access restrictions so that nobody, including AWS employees, can access customer data running in Amazon EC2. The security design of the Nitro System has also been independently validated by the NCC Group in a public report.

With AWS, customers have always had control over the location of their data. In Europe, customers who need to comply with European data residency requirements have the choice to deploy their data to any of our eight existing AWS Regions (Ireland, Frankfurt, London, Paris, Stockholm, Milan, Zurich and Spain) to keep their data securely in Europe. To run their sensitive workloads, European customers can leverage the broadest and deepest portfolio of services, including AI, analytics, compute, database, internet of things, machine learning, mobile services and storage. To further support customers, we’ve innovated to offer more control and choice over their data. For example, we announced further transparency and assurances, and new dedicated infrastructure options with AWS ‘Dedicated Local Zones’.

To deliver enhanced operational resilience within the EU, only EU residents who are located in the EU will have control of the operations and support.

Announcing the AWS European Sovereign Cloud

When we speak to public-sector and regulated-industry customers in Europe, they share how they are facing incredible complexity with an evolving sovereignty landscape. Customers tell us they want to adopt the cloud, but are facing increasing regulatory scrutiny over data location, European operational autonomy and resilience. We’ve learned that these customers are concerned that they will have to choose between the full power of AWS or feature-limited sovereign cloud solutions. We’ve had deep engagements with European regulators, national cybersecurity authorities, and customers to understand how the sovereignty needs of customers can vary based on multiple factors, like location, sensitivity of workloads, and industry. We recently announced our plans to launch the AWS European Sovereign Cloud, a new, independent cloud for Europe, designed to help public sector organizations and customers in highly-regulated industries meet their evolving sovereignty needs. We’re designing the AWS European Sovereign Cloud to be separate and independent from our existing ‘regions’, with infrastructure located wholly within the European Union, with the same security, availability and performance our customers get from existing regions today. To deliver enhanced operational resilience within the EU, only EU residents who are located in the EU will have control of the operations and support for the AWS European Sovereign Cloud. The AWS European Sovereign Cloud will launch its first AWS Region in Germany available to all European customers.

Built on more than a decade of experience operating multiple independent clouds for the most critical and restricted workloads.

The AWS European Sovereign Cloud will be sovereign-by-design, and will be built on more than a decade of experience operating multiple independent clouds for the most critical and restricted workloads. Like existing regions, the AWS European Sovereign Cloud will be built for high availability and resiliency, and powered by the AWS Nitro System, to help ensure the confidentiality and integrity of customer data. Customers will have the control and assurance that AWS will not access or use customer data for any purpose without their agreement. AWS gives customers the strongest sovereignty controls among leading cloud providers. For customers with enhanced data residency needs, the AWS European Sovereign cloud is designed to go further and will allow customers to keep all metadata they create (such as the roles, permissions, resource labels and configurations they use to run AWS) in the EU. The AWS European Sovereign Cloud will also be built with separate, in-region billing and usage metering systems.

Delivering operational autonomy

The AWS European Sovereign Cloud will provide customers with the capability to meet stringent operational autonomy and data residency requirements. To deliver enhanced data residency and operational resilience within the EU, the AWS European Sovereign Cloud infrastructure will be operated independently from existing AWS Regions. To assure independent operation of the AWS European Sovereign Cloud, only personnel who are EU residents, located in the EU, will have control of day-to-day operations, including access to data centers, technical support and customer service.

Control without compromise

Though separate, the AWS European Sovereign Cloud will offer the same industry-leading architecture built for security and availability as other AWS Regions. This will include multiple ‘Availability Zones’, infrastructure that is placed in separate and distinct geographic locations, with enough distance to significantly reduce the risk of a single event impacting customers’ business continuity.

Continued AWS investment in Europe

The AWS European Sovereign Cloud represents continued AWS investment in Europe. AWS is committed to innovating to support European values and Europe’s digital future. We drive economic development through investing in infrastructure, jobs and skills in communities and countries across Europe. We are creating thousands of high-quality jobs and investing billions of euros in European economies. Amazon has created more than 100,000 permanent jobs across the EU. Some of our largest AWS development teams are located in Europe, with key centers in Dublin, Dresden and Berlin. As part of our continued commitment to contribute to the development of digital skills, we will hire and develop additional local personnel to operate and support the AWS European Sovereign Cloud.

Our commitments to our customers

We remain committed to giving our customers control and choices to help meet their evolving digital sovereignty needs. We continue to innovate sovereignty features, controls and assurances globally with AWS, without compromising on the full power of AWS.



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It’s time to hang up on the old telecoms rulebook

Joakim Reiter | via Vodafone

Around 120 years ago, Guglielmo Marconi planted the seeds of a communications revolution, sending the first message via a wireless link over open water. “Are you ready? Can you hear me?”, he said. Now, the telecommunications industry in Europe needs policymakers to heed that call, to realize the vision set by its 19th-century pioneers.

Next-generation telecommunications are catalyzing a transformation on par with the industrial revolution. Mobile networks are becoming programmable platforms — supercomputers that will fundamentally underpin European industrial productivity, growth and competitiveness. Combined with cloud, AI and the internet of things, the era of industrial internet will transform our economy and way of life, bringing smarter cities, energy grids and health care, as well as autonomous transport systems, factories and more to the real world.

5G is already connecting smarter, autonomous factory technologies | via Vodafone

Europe should be at the center of this revolution, just as it was in the early days of modern communications.

Next-generation telecommunications are catalyzing a transformation on par with the industrial revolution.

Even without looking at future applications, the benefits of a healthy telecoms industry for society are clear to see. Mobile technologies and services generated 5 percent of global GDP, equivalent to €4.3 trillion, in 2021. More than five billion people around the world are connected to mobile services — more people today have access to mobile communications than they do to safely-managed sanitation services. And with the combination of satellite solutions, the prospect of ensuring every person on the planet is connected may soon be within reach.

Satellite solutions, combined with mobile communications, could eliminate coverage gaps | via Vodafone

In our recent past, when COVID-19 spread across the world and societies went into lockdown, connectivity became critical for people to work from home, and for enabling schools and hospitals to offer services online.  And with Russia’s invasion of Ukraine, when millions were forced to flee the safety of their homes, European network operators provided heavily discounted roaming and calling to ensure refugees stayed connected with loved ones.

A perfect storm of rising investment costs, inflationary pressures, interest rate hikes and intensifying competition from adjacent industries is bearing down on telecoms businesses across Europe.

These are all outcomes and opportunities, depending on the continuous investment of telecoms’ private companies.

And yet, a perfect storm of rising investment costs, inflationary pressures, interest rate hikes and intensifying competition from adjacent industries is bearing down on telecoms businesses across Europe. The war on our continent triggered a 15-fold increase in wholesale energy prices and rapid inflation. EU telecoms operators have been under pressure ever since to keep consumer prices low during a cost-of-living crisis, while confronting rapidly growing operational costs as a result. At the same time, operators also face the threat of billions of euros of extra, unforeseen costs as governments change their operating requirements in light of growing geopolitical concerns.

Telecoms operators may be resilient. But they are not invincible.

The odds are dangerously stacked against the long-term sustainability of our industry and, as a result, Europe’s own digital ambitions. Telecoms operators may be resilient. But they are not invincible.

The signs of Europe’s decline are obvious for those willing to take a closer look. European countries are lagging behind in 5G mobile connectivity, while other parts of the world — including Thailand, India and the Philippines — race ahead. Independent research by OpenSignal shows that mobile users in South Korea have an active 5G connection three times more often than those in Germany, and more than 10 times their counterparts in Belgium.

Europe needs a joined-up regulatory, policy and investment approach that restores the failing investment climate and puts the telecoms sector back to stable footing.

Average 5G connectivity in Brazil is more than three times faster than in Czechia or Poland. A recent report from the European Commission — State of the Digital Decade (europa.eu) shows just how far Europe needs to go to reach the EU’s connectivity targets for 2030.

To arrest this decline, and successfully meet EU’s digital ambitions, something has got to give. Europe needs a joined-up regulatory, policy and investment approach that restores the failing investment climate and puts the telecoms sector back to stable footing.

Competition, innovation and efficient investment are the driving forces for the telecoms sector today. It’s time to unleash these powers — not blindly perpetuate old rules. We agree with Commissioner Breton’s recent assessment: Europe needs to redefine the DNA of its telecoms regulation. It needs a new rulebook that encourages innovation and investment, and embraces the logic of a true single market. It must reduce barriers to growth and scale in the sector and ensure spectrum — the lifeblood of our industry — is managed more efficiently. And it must find faster, futureproofed ways to level the playing field for all business operating in the wider digital sector.  

But Europe is already behind, and we are running out of time. It is critical that the EU finds a balance between urgent, short-term measures and longer-term reforms. It cannot wait until 2025 to implement change.

Europeans deserve better communications technology | via Vodafone

When Marconi sent that message back in 1897, the answer to his question was, “loud and clear”. As Europe’s telecoms ministers convene this month in León, Spain, their message must be loud and clear too. European citizens and businesses deserve better communications. They deserve a telecoms rulebook that ensures networks can deliver the next revolution in digital connectivity and services.



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PTFE ban: The hidden consumer costs and employment losses

As part of the EU’s landmark Green Deal package, the 2020 Chemicals Strategy for Sustainability called for an ambitious concept: achieving a toxic-free environment by 2030. A central pillar of this ambition is the proposal for a universal PFAS — per- and polyfluoroalkyl substances — restriction, addressing contamination and emissions from the controversial family of substances sometimes known as ‘forever chemicals’.

Action to tackle this family of chemicals is overdue, and European industry is ready to do its part. As the president of the Federation of the European Cookware, Cutlery and Houseware Industries (FEC), I welcome the initiative. FEC members pride themselves on providing safe and durable products to consumers, and were early to phase out these problematic substances. Despite this, the current restriction proposal still needs substantial changes to achieve its goals of protecting human health and the environment while balancing socioeconomic effects, impacts on carbon emissions and circularity.

While many elements of the proposed restriction are well justified, some risk damaging the EU industry’s competitiveness and hindering progress on the green and digital transitions, all while banning substances which are known to be safe. The European authorities need to understand the impacts of the proposal more thoroughly before making decisions which will harm consumers and the European workforce, and perhaps even result in worse environmental outcomes.

The current restriction proposal still needs substantial changes to achieve its goals of protecting human health and the environment while balancing socioeconomic effects.

As the most complex and wide-ranging chemical restriction in EU history, it is essential that the institutions take no shortcuts, and take the time to clearly understand the unintended environmental and socioeconomic impacts on every sector.

The PFAS restriction proposal is broad, covering over 10,000 substances, many of which were not considered part of the PFAS family in the past. In an effort to catch all possible problematic chemicals that could be used in the future, the member countries which proposed the restriction have cast a net so wide that it also includes substances which pose no risk. Even the OECD, the source of the broad scope used by the authorities, concedes that its definition is not meant to be used to define the list of chemicals to be regulated.

In addition to the legacy PFAS substances, which have serious concerns for human health and the environment, the proposal also includes fluoropolymers in its scope, which are not mobile in the environment, not toxic and not bioaccumulative — a stark contrast to the controversial PFAS substances at the center of contamination scandals across Europe and around the globe.

As the most complex and wide-ranging chemical restriction in EU history, it is essential that the institutions take no shortcuts.

Fluoropolymers are well studied, with ample scientific evidence demonstrating their safety, and unlike legacy PFAS, technologies exist to control and eliminate any emissions of substances of concern from manufacturing to disposal.

Fluoropolymers are not only safe, their safety is a primary reason for their widespread use. They provide critical functionality in sensitive applications like medical devices, semiconductors and renewable energy technology. They are also used in products we all use in our day-to-day lives, from non-stick cookware to electrical appliances to cars. While in some cases there are alternatives to fluoropolymers, these replacements are often inferior, more expensive, or have even more environmental impact in the long run. Where alternatives aren’t yet identified, companies will need to spend large sums to identify replacements.

In the cookware industry, for example, fluoropolymers provide durable, safe and high-performing non-stick coatings for pots, pans and cooking appliances used by billions of people across Europe and around the globe. Decades of research and development show that not only are these products safe, but their coatings provide the most high-performing, durable and cost-effective solution. Continued research and development of these products is one of the reasons that the European cookware industry is considered a world leader.

Fluoropolymers are well studied, with ample scientific evidence demonstrating their safety and … technologies exist to control and eliminate any emissions of substances of concern from manufacturing to disposal.

Given the critical role that fluoropolymers play in so many products and technologies, forcing a search for inferior or even nonexistent alternatives will harm the EU’s competitiveness and strategic autonomy. In the cookware industry alone, the restriction could cost up to 14,800 jobs in Europe, reduce the economic contribution of the sector to the GDP by up to €500 million, and result in a major shift of production from Europe to Asia, where the products would be made under much less stringent environmental rules. Consumers will also suffer, with new alternatives costing more and being less durable, requiring more frequent replacement and therefore resulting in a larger environmental impact.

Beyond this, companies that enable the green transition, deliver life-saving medical treatments, and ensure our technology is efficient and powerful will all be required to engage in expensive and possibly fruitless efforts to replace fluoropolymers with new substances. What would be the benefit of these costs and unintended consequences, when fluoropolymers are already known to be safe across their whole lifecycle?

Given the critical role that fluoropolymers play in so many products and technologies, forcing a search for inferior or even nonexistent alternatives will harm the EU’s competitiveness and strategic autonomy.

The scale of the PFAS restriction is unprecedented, but so are the possible unintended consequences. Industry has contributed comprehensive evidence to help fill in the blanks left by the initial proposal, it is now up to the institutions to take this evidence into account. With such a far-reaching initiative, it is essential that the EU institutions and the member countries thoroughly consider the impacts and ensure the final restriction is proportional, preserves European competitiveness and does not undermine the broader strategic objectives set for the coming years.

Founded in 1952, FEC, the Federation of the European Cookware, Cutlery and Housewares Industries, represents a strong network of 40 international companies, major national associations and key suppliers spread over Europe, including in Belgium, Croatia, France, Germany, Italy, Spain, Switzerland and the Netherlands. Our mission is to promote cooperation between members, and to provide expertise and support on economic and technical topics.



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Harnessing innovation in robotic-assisted surgery


For nearly three decades, Intuitive has been developing innovative approaches in the field of minimally-invasive care. We are guided by the belief that minimally-invasive care can be life changing, that patient outcomes can be profoundly improved and that enhanced clinical outcomes can sustainably lower the total cost of comprehensive care.

Our focus is on helping customers in Europe and around the world achieve better outcomes, better surgeon and care team experiences, better patient experiences and lower cost of care. Positive impact in these areas requires a holistic effort that includes not only leading-edge, integrated systems and software, but also an ecosystem of education and support that extends across the patient care pathway and the broader health care system.

What is robotic-assisted surgery?

27 years ago, Intuitive launched the da Vinci robotic-assisted surgical system, transforming the field of minimally-invasive surgery.

Robotic-assisted surgery is a form of minimally-invasive surgery performed by a surgeon using a computer-assisted system to operate through small incisions using tiny, wristed instruments. Robotic-assisted surgical systems do not perform surgery on their own and they do not replace surgeons. Surgeons completely control da Vinci robotic-assisted surgical systems, while seated at an ergonomic console that uses high-definition, 3D vision to magnify the patient’s anatomy. The surgical system translates the surgeon’s hand movements in real time to bend and rotate the instruments with greater flexibility, precision and range of motion than the human hand. This approach can augment a surgeon’s skills and capabilities while allowing them to continue to apply their judgment and experience.

To date, more than 12 million da Vinci robotic-assisted surgical procedures have been performed worldwide — including more than 1.2 million in Europe — across a range of procedures including urology, gynecology, colorectal, thoracic, general surgery and more.

Robotic-assisted surgery is a form of minimally-invasive surgery performed by a surgeon using a computer-assisted system to operate through small incisions using tiny, wristed instruments.

A growing body of research, including more than 34,000 peer-reviewed studies, suggests that minimally-invasive, robotic-assisted surgery can offer patients benefits in many cases, depending on the procedure, including one or more of these benefits: less blood loss, fewer complications, shorter hospital stays, and less chance of hospital readmission.[i]

The added value of robotic-assisted surgery for European health care systems

Since the first robotic-assisted da Vinci prostatectomy was performed in Germany nearly 20 years ago, more than 1,500 da Vinci systems have been installed in Europe, highlighting Europe’s strong demand for this innovative technology. But, while Europe has helped drive this technology forward, more can be done to help hospitals in Europe become world leaders in the 21st century.

Similar to health care systems around the world, Europe faces challenges including rising health care costs, a pressured workforce, aging populations and increasing burdens of disease. At the same time, patients across Europe are seeking equitable access to innovative, high-quality care.

Using our more than two decades of experience working with hospitals and health care systems across Europe, we strive to offer solutions to these multifaceted challenges that are aligned with our customers’ clinical and economic capabilities and goals. A key insight from our experience is that we must provide more than a “robotic-assisted surgical system”; we must be a “technology-enabled solutions partner and provider”. Robotic-assisted surgery as a modality can help drive better patient outcomes; robotic-assisted surgical programs as a key part of a hospital’s care pathway can help optimize the cost and efficiency and advance the delivery and quality of care.

As one example, we collaborate with hospitals to examine opportunities to sustainably increase throughput and introduce efficiencies that can allow them to treat more patients and reduce patient backlogs. Solutions that our customers have enacted as a result of these engagements include improving operating room set up time, scheduling optimization, standardizing pre-operative planning for care teams, and starting surgical days earlier. 

In all cases, we work to assure that any effort is seamlessly integrated into the workflows of our hospital customers and their broader patient care pathways, and that our success is defined and measured in alignment with their goals.

Training

Central to our holistic approach is our technology training, which is essential to maximize patient safety and a vital part of any successful robotic-assisted surgery program. Our four-phase training pathway combines skills and technology training with opportunities for health care professionals around the world to learn from their peers. Our robust training offerings include a combination of simulation, virtual learning, in-person observation and hands-on training, with high-quality tissue models and peer-to-peer mentoring, proctoring and advanced learning opportunities. The training tools and technologies we offer are informed by our unique understanding of best practices and can help users build their skills by targeting individualized areas for improvement.

We believe that our robust training programs are contributing to the development of the next-generation health care workforce.

Last year, we became the largest provider of robotic-assisted surgical technology training to have our full global training portfolio accredited by The Royal College of Surgeons. And, our industry-leading offerings are more available than ever across both virtual and in-person opportunities; we now have more than 25 training centers and partnerships across Europe.

Looking forward, we believe that our robust training programs are contributing to the development of the next-generation health care workforce and motivating existing surgical staff to stay within our health care systems. We will continue to evolve and innovate our training offerings by listening to and learning from surgeons and teams to identify the practices that lead to better results and hone our efforts to offer meaningful interoperative guidance.

Total cost to treat

While there is an upfront investment in robotic-assisted technology, the experience of hospitals across Europe shows that da Vinci systems can help realize a return on this investment. The benefits of minimally-invasive care — fewer complications and readmissions, less blood loss, less pain — help to avoid higher ‘downstream’ costs and resource use associated with traditional, or “open” surgery, which typically requires longer hospital stays and presents a greater risk of post-operative complications.[ii] Robotic-assisted approaches, like the da Vinci system, can therefore help to reduce the costs and resources associated with a complete patient journey, or ‘episode of care’.

An important indicator of the economic value of this cost avoidance can be found in hospitals’ investment decisions in recent years. Based on their own medical records, financial data, and unique reimbursement and cost structures, hospitals are increasingly choosing to commit to robotic-assisted technology. Our own data shows that the number of hospital Integrated Delivery Networks, or IDN’s, with more than seven da Vinci systems has increased by more than 150 percent in the past five years.[iii] We believe this demonstrates a trend from cautious adoption to standardization based on recognized value. This trend brings the benefits of minimally-invasive care to an increasingly larger number of users, helping to accelerate and compound the potential savings to the health care system over time.

A vision for 2030: a future of European health care excellence

The next European Commission term will almost reach the end of this decade, serving as a useful marker for us to imagine where Europe could be in health care delivery by 2030.

Looking ahead, it will be essential that policymakers create an environment where advancements in robotic-assisted tools and technology, digital health and patient-focused innovation can be seamlessly integrated in a way that prioritizes patient safety and facilitates equitable access to and adoption of innovative technology.

The infrastructure and tools needed for future success are already present. Europe can lead the way in creating this environment, in part by avoiding policies which inhibit this kind of integration and innovation through duplicative or conflicting regulatory structures. We look forward to contributing to an ambitious agenda to bring cutting-edge health care, training, and innovations to European patients and health care professionals.

This material may contain estimates and forecasts from which actual results may differ.


[i] Bhama, A. R., et al. (2016). “Comparison of Risk Factors for Unplanned Conversion from Laparoscopic and Robotic to Open Colorectal Surgery Using the Michigan Surgical Quality Collaborative (MSQC) Database.” Journal of Gastrointestinal Surgery: 1-8

Oh, D. S., et al. (2017). “Robotic-Assisted, Video-Assisted Thoracoscopic and Open Lobectomy: Propensity-Matched Analysis of Recent Premier Data.” Annals of Thoracic Surgery 104(5): 1733-1740.

Ran, L., et al. (2014). “Comparison of robotic surgery with laparoscopy and laparotomy for treatment of endometrial cancer: a meta-analysis.” PLoS ONE 9(9): e108361.

Speicher, P. J., et al. (2014). “Robotic Low Anterior Resection for Rectal Cancer: A National Perspective on Short-term Oncologic Outcomes.” Annals of Surgery.

Tam, M. S., et al. (2015). “A population-based study comparing laparoscopic and robotic outcomes in colorectal surgery.” Surgical Endoscopy and Other Interventional Techniques.

Pilecki, M., et al. (2014). „National Multi-Institutional Comparison of 30-Day Postoperative Complication and Readmission Rates Between Open Retropubic Radical Prostatectomy and Robot-Assisted Laparoscopic Prostatectomy Using NSQIP (National Surgical Quality Improvement Program)“ Journal of Endourology, 430 – 436.

Tewari A, et al. “Positive Surgical Margin and Perioperative Complication Rates of Primary Surgical Treatments for Prostate Cancer: A Systematic Review and Meta-Analysis Comparing Retropubic, Laparoscopic, and Robotic Prostatectomy,” Eur Urol. 2012 Feb 24.7.

Carbonell, A. M., et al. (2017). “Reducing Length of Stay Using a Robotic-Assisted Approach for Retromuscular Ventral Hernia Repair: A Comparative Analysis from the Americas Hernia Society Quality Collaborative,” Annals of Thoracic Surgery.

Lim, P. C., et al. (2016). “Multicenter analysis comparing robotic, open, laparoscopic, and vaginal hysterectomies performed by high-volume surgeons for benign indications,” International Journal of Gynecology and Obstetrics.

O’Neill, Michelle, et al. “Robot-assisted hysterectomy compared to open and laparoscopic approaches: systematic review and meta-analysis,” Archives of gynecology and obstetrics 287.5 (2013): 907-918.

Geppert B, Lönnerfors C, Persson J. “Robot-assisted laparoscopic hysterectomy in obese and morbidly obese women: surgical technique and comparison with open surgery.”  Acta Obstet Gynecol Scand. 90.11 (2011): 1210-1217. doi: 10.1111/j.1600-0412.2011.01253.x. Epub.

[ii] Id.

[iii] Intuitive internal data measuring from year end 2017 to year end 2022.



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Why we need to improve heart health in Europe

Cardiovascular diseases (CVDs) are the number one killer in Europe. They cost the EU an estimated €282 billion in 2021, larger than the entire EU budget itself.[1] Sixty million people live with CVDs in the EU, while 13 million new cases are diagnosed annually.[2]

Behind this data are individual stories of suffering and loss, of lives limited and horizons lowered by, for example, heart attack and stroke. These diseases directly affect every community in every country. And they strain our health services which must respond to cardiac emergencies as well as the ongoing care needs of chronic CVD patients.

Sixty million people live with CVDs in the EU, while 13 million new cases are diagnosed annually.

Cardiovascular health is a priority not just because of the scale of its impact, but because of the scope we see for significant advances in outcomes for patients. We should take inspiration from the past: between 2000 and 2012, the death rate from CVDs fell by 37 percent in the five largest western European countries (France, Germany, the U.K., Spain and Italy).[2] This progress was achieved through a combination of medical innovations, and supported by a mix of health care policies and guidelines that propelled progress and improved patients’ lives.

New treatments can now help prevent strokes or treat pulmonary embolisms. Others can delay kidney disease progression, while at the same time preventing cardiovascular events.

Despite progress, this downward trend has reversed and we are seeing an increase in the CVD burden across all major European countries.

And the research continues. Precision medicines are in development for inherited CVD-risk factors like elevated lipoprotein(a), which affects up to 20 percent of the population.[3] A new class of anti-thrombotics promises to bring better treatments for the prevention of clotting, without increasing the risk of bleeding. New precision cardiology approaches, such as gene therapy in congestive heart failure, are being investigated as potential cures.

Despite progress, this downward trend has reversed and we are seeing an increase in the CVD burden across all major European countries.[4]

Getting the definitions right

This year’s World Heart Day, spearheaded by the World Heart Federation, comes amid the revision of the EU pharmaceutical legislation. The European Commission’s proposal of a narrow definition of unmet medical need, which could hamper innovation is causing deep concern across stakeholders.

Instead, a patient-centered definition of unmet medical need taking the full spectrum of patient needs into consideration, would incentivize more avenues of research addressing the needs of people living with chronic conditions. It would provide a basis for drafting the next chapter in the history of cardiovascular medicines — one that we hope will be written in Europe and benefit people in the EU and beyond. Not only would this inspire advances that help people to live longer, but it would also improve quality of life for those at risk of, and affected by, cardiovascular events.

Unmet medical need criteria currently included in the draft Pharmaceutical Legislation would do a disservice to patients by downplaying the chronic nature of many CVDs, and the importance of patient-reported outcomes and experience.[5] And many of the advances seen in recent decades would fall short of the narrow definition under consideration. This limited approach disregards incremental innovation, which might otherwise reduce pain, slow disease progression, or improve treatment adherence by taking account of patient preferences for how therapies are administered.

Much of the illness and death caused by CVD is preventable — in fact, 9 out of 10 heart attacks can be avoided.

At this moment it is unclear how the unmet medical need criteria in the legislation will apply to these and other situations. Policymakers should create a multistakeholder platform with the space to discuss patients’ needs, getting expert views from medical societies, patients and industry to better understand the innovation environment. The European Alliance for Cardiovascular Health (EACH), a multistakeholder network comprised of 17 organizations in the CVD space in Europe, stands ready to inform policymakers about the CVD burden and the pressing needs of patients. [6] EACH not only supports the EU´s endeavor to develop more policies on CVD, it also supports and promotes the idea of an EU Cardiovascular Health Plan to work towards better patients’ health care across the EU and more equal health standards. So far, structured discussions with such stakeholders do not sufficiently take place, and we risk missing those opportunities, and lose in both patient access as well as R&D attractiveness of the EU.

Primary and secondary prevention

As well as driving future innovation, Europe must also make the best possible use of the tools we have now. We must do what works — everywhere.

At the heart of this approach is prevention. Much of the illness and death caused by CVD is preventable — in fact, 9 out of 10 heart attacks can be avoided.[7] Primary prevention can dramatically reduce rates of heart attack, stroke and other CVDs. Secondary prevention, which includes screening and disease management, such as simple blood tests and urine tests, as well as blood pressure and BMI monitoring, has a key role to play in containing the burden of disease. [8]

Joint cardiovascular and diabetes health checks at primary care level, taking an evidence-based approach, would help diagnose and treat CVD before the onset of acute symptoms.[9] By following current treatment guidelines and protocols, health care professionals across Europe can help to prevent complications, improve health outcomes for patients and save health care costs. Also here, a multistakeholder approach is key. Policymakers should not miss out on listening to the CVD multistakeholder alliances that have already formed — at EU and at EU member countries level, as for example EACH. These partnerships are great ways for policymakers to better understand the needs of patients and to get the experts’ views.

Research-driven companies exist to meet the needs of patients in Europe and around the world. We need to create an environment that enables companies to embark on complex and unpredictable trials. That means having the rights incentives and clarity on the regulatory pathway for future treatments.


[1] https://www.escardio.org/The-ESC/Press-Office/Press-releases/Price-tag-on-cardiovascular-disease-in-Europe-higher-than-entire-EU-budget

[2] https://iris.unibocconi.it/retrieve/handle/11565/4023471/115818/Torbica%20EHJ%202019.pdf

[3] https://www.acc.org/Latest-in-Cardiology/Articles/2019/07/02/08/05/Lipoproteina-in-Clinical-Practice

[4] https://www.efpia.eu/about-medicines/use-of-medicines/disease-specific-groups/transforming-the-lives-of-people-living-with-cardiovascular-diseases/cvd-dashboards

[5] https://health.ec.europa.eu/medicinal-products/pharmaceutical-strategy-europe/reform-eu-pharmaceutical-legislation_en

[6] https://www.cardiovascular-alliance.eu/

[7] https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.024154

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5331469/

[9] https://www.efpia.eu/news-events/the-efpia-view/statements-press-releases/because-we-can-t-afford-not-to-let-s-make-a-joint-health-check-for-cardiovascular-disease-cvd-and-diabetes-happen/



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Knowledge gaps for perishable liquid food packs threaten Green Deal

Professor Fredrik Nilsson, Packaging Logistics, Faculty of Engineering, Lund University

Policymakers are currently deliberating on packaging reuse targets in the proposed EU Packaging and Packaging Waste Regulation (PPWR). But do they have the necessary evidence to make those decisions for all packaged products? A systematic review of 159 relevant scientific studies on packaging alternatives for perishable liquid foods[1] — milk, juices, nectars and plant-based drinks — suggests there is a clear gap in holistic impact assessment knowledge.

Packaging of perishable liquid foods exists in various forms such as aseptic paper-based beverage cartons or non-aseptic solutions such as plastic or glass bottles. Each packaging solution has an impact on the quality, safety and shelf life of the food it contains. In assessing packaging solutions, efforts should be made to understand the wider context of reuse targets for perishable liquid foods, with consideration for packaging types, food security, food safety, food waste and environmental impacts.

In both research and policy contexts, packaging is still often considered separately from its contents in impact assessments.

However, in both research and policy contexts, packaging is still often considered separately from its contents in impact assessments, despite an existing body of knowledge and evidence showing that food and its packaging should be treated as an integrated unit.

Consequently, policymakers served only with evidence of packaging impacts could be misled and make inaccurate decisions when discussing the measures included in the proposed EU Packaging and Packaging Waste Regulation (PPWR). This risks undermining the EU’s Green Deal ambitions.

The importance of the analysis

One of the primary objectives of the proposed PPWR is to ensure that “all packaging in the EU is reusable or recyclable in an economically viable way by 2030”, in line with the EU Green Deal and the EU Circular Economy Action Plan. Setting reusable packaging targets was always likely to spark a robust debate with the food industry. The European food system uses a large amount of packaging and the use of single-use packaging in particular has grown significantly in the past decades. For perishable liquid foods, producers today prefer recyclable single-use packaging — such as aseptic beverage cartons — for the sale of 75 percent of milk, 59 percent of juices and a major share of plant-based drinks in the EU[2].

We undertook a comprehensive and systematic analysis of all identifiable studies on single-use versus reusable packaging for perishable liquid foods.

With a specific focus on the 154 billion liters of perishable liquid foods produced in the EU each year[3], a more fundamental question occurred to the Packaging Logistics division in the Faculty of Engineering at Lund University. We wondered if a sufficient body of evidence existed to help policymakers make packaging reuse decisions, so we undertook a comprehensive and systematic analysis of all identifiable studies on single-use versus reusable packaging for perishable liquid foods.

The scale of the knowledge gap that we uncovered was eye-opening.

Findings from the study

Based on an analysis of 159 identified scientific papers, we came to three main conclusions.

First, the research and knowledge of food waste for single-use packaging compared to reusable packaging alternatives for perishable liquid foods was clearly insufficient. No studies were found that evaluated reusable packaging for such foods in relation to food waste, consequently no studies were found comparing single-use packaging with reusable packaging in this regard. A few studies were found that evaluated different single-use packaging alternatives in terms of the packaging and the liquid food being contained, finding that multilayer carton packages had the lowest environmental impact. Most environmentally-focused studies on food packaging did not consider the food saved or wasted.

The research and knowledge of food waste for single-use packaging compared to reusable packaging alternatives for perishable liquid foods was clearly insufficient.

Second, there were few studies comparing reusable and single-use packaging for perishable liquid foods in terms of food safety and quality. Instead, the majority of sampled papers simply provided insights and evidence for critical factors to be considered in food production and supply chain handling to keep liquid foods safe and of sufficient quality. This analysis surfaced several challenges related to reusable packaging, some related to food safety and others to quality limitations. For example, some studies pointed out quality-related challenges from plastic refillable bottles, such as the absorption of chemicals from previous use.

Finally, while there were many papers addressing shelf life as a critical aspect for perishable liquid foods — and many that empirically provided evidence of lower food waste in retail and at the consumer stage when shelf life is prolonged — there were still sizable knowledge gaps. No studies were found that compared the shelf life of single-use versus reusable packaging for perishable liquid foods. None were found that evaluated the shelf life of reusable packaging for such foods in relation to food waste, and none were found that clarified what optimal shelf life is for different products.

In our view, the key knowledge gaps at this time are: evidence of food waste impacts for reusable alternatives, so that a comparison with recyclable single-use packaging is possible; comparative studies on food safety and quality impacts through using single-use and reusable alternatives; shelf life comparisons; impact assessments that also take into account climate and land-use impacts; and, most importantly, food packaging studies that take into account the product that the packaging contains and protects. 

Key knowledge gaps need to be addressed

Policymakers should be insisting on accessing a more holistic knowledge base built on assessment of impact, before they finalize reusable packaging targets in the PPWR. 

The evidence we have today suggests that greater food safety, food security and food quality could be achieved by increasing the use of recyclable single-use packaging.

A more holistic perspective is crucial to help policymakers avoid measures that might miss higher environmental gains, compromise consumers’ health and wellbeing, and reconfigure the packaging industry. Further knowledge might indicate that reusable packaging for perishable liquid foods is feasible under specific circumstances. However, the evidence we have today suggests that greater food safety, food security and food quality could be achieved by increasing the use of recyclable single-use packaging. Support for that choice is already demonstrated today through the packaging chosen by the majority of European milk, juice and plant-based drink producers.


[1] Perishable foods are defined in EU legislation under Regulation (EU) No 1169/2011 as foods which, from a microbiological point of view, are highly perishable and are therefore likely after a short period to constitute an immediate danger to human health.

[2] AIJN, Liquid Fruit Market Report, 2018, p.7 https://aijn.eu/files/attachments/.598/2018_Liquid_Fruit_Market_Report.pdf

[3] Key figures on the European food chain, Eurostat, 2021



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