Ukraine needs a government of national unity

Adrian Karatnycky, a senior fellow of the Atlantic Council and the author of the forthcoming book, “Battleground Ukraine: From Independence to the War with Russia” (Yale University Press).

In recent weeks, discourse about the war with Russia has turned deeply pessimistic in Ukraine.

A difficult Ukrainian counter-offensive, with lesser results than anticipated, has fueled deeply dark discussions about a deadlocked and bloody long-term war with Russia. Meanwhile, analysts and politicians have started to snipe at Ukraine’s military and political leaders, blaming them for the war effort’s failure and even speculating about defeat.

Further feeding this atmosphere of pessimism is evidence of tension between Ukrainian President Volodymyr Zelenskyy and the country’s military command, as well as delays in military aid from the United States. And these pressures now need to be addressed.

Clearly, the period of euphoria propelled by major Ukrainian military victories and territorial advances is over. So, too, is the period of grandiose promises by Ukrainian officials.

Last winter, an official spokesman for the president had proclaimed he expected to spend the next summer in Crimea. No less extravagant a promise was echoed by the head of military intelligence, who predicted Crimea would be liberated within six months, bringing official promises of a major spring counter-offensive with significant territorial gains along with it.

Early battlefield success also contributed to near universal approval for Zelenskyy among Ukrainians. Despite slow Russian advances in the Donbas and scant Ukrainian victories later on, happy talk on the state-dominated TV “marathon” — joint programming produced by the bulk of the country’s main television networks — continued to promote frontline success, helping Zelenskyy maintain his popularity.

All this changed, however, when Ukraine’s 2023 counter-offensive stalled. The massive loss of fighters amid meagre gains and a slow-moving positional war eroded public trust in the president and his team for the first time since the war began.

A subsequent mid-November poll gave Zelenskyy a trust rating of only net 32 percent plus — meaning two-thirds of Ukrainians trusted the president, while a third now did not. This was a steep decline from polls earlier in the year, and far below the trust ratings of the armed forces and their commander, General Valery Zaluzhny.

A later poll conducted for the President’s Office and leaked to the Ukrainska Pravda news site showed Zelenskyy was neck and neck with Zaluzhny in a hypothetical race for president. Moreover, Zelenskyy’s Servant of the People party — which currently holds over two-thirds of the seats in parliament — would see its presence shrink dramatically if elections were held today.

And as Zelenskyy’s support weakens, Ukraine now faces a number of challenges and difficult decisions. These include a deadlock on the front, a rapidly depleting supply of munitions, some erosion of support from Europe, and an impasse in the U.S. Congress over a bill to provide for the military needs of both Ukraine and Israel. His star power notwithstanding, Zelenskyy faces new difficulties in maintaining high levels of military and financial support for Ukraine both in North America and in Europe.

Additionally, the ranks of Ukraine’s armed forces — initially populated by experienced military professionals with combat experience and highly motivated volunteers — have suffered mass casualties during these brutal two years of war. Аs a result, military recruiters — now called “people snatchers” — are scouring cities and villages in search of males aged 18 to 60 for military service. Sometimes, these recruiters are not merely using coercive tactics against draft dodgers but detaining and pressuring those not called or exempt from service into signing on. And such tactics are contributing to justifiable public anger toward the authorities

In addition to such unpopular tactics, Zelenskyy will soon likely need to need to dramatically widen the national military mobilization and shift social spending toward military expenditures, if only to hedge against any decline in, or interruption of, financing from key allies. Both moves will be highly unpopular.

All this doesn’t mean Russia will prevail. Indeed, Ukraine has basically fought Russia to a standstill. Taking minor territorial losses in the Donbas, while gaining modest territory in the south and forcing Russia’s navy to the eastern reaches of the Black Sea, it has effectively restored freedom of navigation for commercial vessels in the sea’s west.

Zelenskyy has also been a courageous and successful wartime leader. But much of this was dependent on steadfast public support. Near-universal domestic approval gave him political carte blanche to shape policy and strategy. But while Ukrainians remain united in their aim of defending the country, unqualified support for Zelenskyy and his policies is declining. And the embattled democracy is subsequently witnessing a revival in national politics.

Zelenskyy’s team itself has contributed to this politicization. After Zaluzhny soberly spoke about the difficulties of Ukraine’s war effort, while providing a road map that could ensure victory, his public comments were shot down by officials from the President’s Office.

In early November, Zelenskyy’s foreign policy advisor Ihor Zhovkva went on national television to assert that Zaluzhny’s statement “eases the work of the aggressor” by stirring “panic,” adding there should be no public discussion of the situation at the front. Zelenskyy himself then chided the general in an interview, warning the military not to engage in politics.

Deputy Head of the Committee on National Security, Defense and Intelligence Maryana Bezuhla piled on, alleging Zaluzhny had ignored U.S. General Mark Milley’s recommendations to mine Ukraine’s border with Russian occupied Crimea back in 2021 — an act of negligence, she implied, that cost Ukraine large swaths of territory in the south. However, Zelenskyy is unlikely to seek Zaluzhny’s dismissal, as it would instantly launch the soldier on a political career.

And that’s not all. On the heels of this kerfuffle, Zelenskyy’s allies in parliament then blocked a visit to Poland and the U.S. by former Ukrainian President Petro Poroshenko. The ostensible reason behind this was a report from Ukraine’s security service suggesting Poroshenko’s trip would be exploited by Russian propaganda. Of particular concern was a planned meeting between Poroshenko and Hungarian Prime Minister Viktor Orbán.

The idea that a seasoned leader like Poroshenko, whose tenure as president earned Western praise for his diplomatic skills, could be manipulated is, on the face of it, preposterous. And it later turned out that Zelenskyy himself would be meeting Orbán and didn’t want to be preempted.

These clear fractures need to be dealt with now.

Furthermore, as importantly, as domestic support erodes, Zelenskyy’s term in office is due to formally expire in May 2024, while the parliament’s four-year term expired in October. New elections are well-nigh impossible with millions of voters outside the country, a million engaged at the front and millions more internally displaced or under Russian occupation. Elections amid bloody combat and constant missiles and drone attacks on urban centers are unlikely, and would require both legislative and constitutional changes.

This issue of expiring mandates would be moot were the ratings of Zelenskyy and his party unassailable, but polls show a creeping disenchantment with both.

In this context, the time is ripe for Ukraine’s president to consider establishing a broad-based government of national unity. Opening the government to opposition and civil society leaders in this way would instantly provide legitimacy to the leadership team, reduce opposition criticism and widen the circle of voices that have the president’s ear.

There are compelling precedents for such a step too. For example, as World War II began, Conservative Prime Minister Winston Churchill understood Britain faced an existential threat that required sustaining national unity and created a broad-based coalition government. Churchill installed his main rival — Labour leader Clement Attlee — as deputy prime minister, and added Labour’s Ernest Bevin, a former trade union leader, to the national unity cabinet.

Similarly, this practice was followed most recently by Israeli Prime Minister Benjamin Netanyahu, who offered opposition party leaders a place in a unity government after Hamas’s brutal October 7 attacks. The proposal was accepted by centrist Benny Gantz.

Since the beginning of his presidency, Zelenskyy has relied on an exceedingly narrow circle of trusted advisors. But while he meets with his top military command, intelligence officials, visiting Western leaders and the media, he has largely shut himself off from civic leaders, political critics and rivals — including some with important foreign policy, national security and economic experience.

Their inclusion in leadership posts would offer Zelenskyy additional input on policy options, allow for discussions of alternative tactics and contribute to new approaches when it comes to external relations. With national unity showing signs of fraying, a government that includes the opposition would truly give it a boost.

The only questions are whether Zelenskyy is flexible enough to overcome his contempt for most opposition leaders, and change his style of governing from highly centralized decision-making to more broad-based consensus-building.



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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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Making water the engine for climate action

Much progress has been made on water security over recent decades, yet for the first time in human history, our collective actions have pushed the global water cycle out of balance. Water is life: it is essential for health, food, energy, socioeconomic development, nature and livable cities. It is hardly surprising that the climate and biodiversity crises are also a water crisis, where one reinforces the other. Already, a staggering four billion people suffer from water scarcity  for at least one month a year and two billion people lack access to safely-managed drinking water. By 2030, global water demand will exceed availability by 40 percent. By 2050, climate-driven water scarcity could impact the economic growth of some regions by up to 6 percent of their Gross Domestic Product per year.

Meike van Ginneken, Water Envoy of the Kingdom of the Netherlands

Right now, the world’s first Global Stocktake is assessing the progress being made toward the goals of the Paris Agreement and global leaders are convening at COP28 in Dubai to agree on a way forward. We have a critical opportunity to catalyze global ambition and recognize that water is how climate change manifests itself. While wealthier, more resilient nations may be able to manage the devastating impacts of climate change, these same challenges are disastrous for lesser developed, more vulnerable communities.

Rainfall, the source of all freshwater, is becoming more erratic. Changes in precipitation, evaporation and soil moisture are creating severe food insecurity. Droughts trap farmers in poverty, as the majority of cultivated land is rain-fed. Extreme drought reduces growth in developing countries by about 0.85 percentage points. Melting glaciers, sea-level rise and saltwater intrusion jeopardize freshwater supplies. Floods destroy infrastructure, damage homes and disrupt livelihoods. The 2022 Pakistan floods affected 33 million people and more than 1,730 lost their lives, while 2023 saw devastating floods in Libya among other places.  

Now more than ever, it is urgent that we work together to make water the engine of climate action. Already, many countries are investing in technology and climate-resilient water infrastructure. Yet, we need more than technology and engineering to adapt to a changing climate. To advance global water action, we must radically change the way we understand, value and manage water with an emphasis on two necessary measures.

First, we need to make water availability central to our economic planning and decision-making. We need to rethink where and how we grow our food, where we build our cities, and where we plan our industries. We cannot continue to grow thirsty crops in drylands or drain wetlands and cut down forests to raise our cattle. In a changing climate, water availability needs to guide where we undertake economic activity.

In a changing climate, water availability needs to guide where we undertake economic activity.  

Second, we must restore and protect natural freshwater stocks, our buffers against extreme climate events. Natural freshwater storage is how we save water for dry periods and freshwater storage capacity is how we store rainwater to mitigate floods. 99 percent of freshwater storage is in nature. We need to halt the decline of groundwater, wetlands and floodplains. But our challenge is not only about surface and groundwater bodies, or blue water. We also need to preserve and restore our green water stocks, or the water that remains in the soil after rainfall. To reduce the decline of blue water and preserve green water, we need to implement water-friendly crop-management practices and incorporate key stakeholders, such as farmers, into the decision-making process.

Addressing the urgency of the global water crisis goes beyond the water sector. It requires transformative changes at every level of society. National climate plans such as Nationally Determined Contributions (NDCs) and National Adaptation Plans are key instruments to make water an organizing principle to spatial, economic and investment planning. Much like the Netherlands did earlier this year when the Dutch parliament adopted a policy that makes water and soil guiding principles in all our spatial planning decisions. Right now, about 90 percent of all countries’ NDCs prioritize action on water for adaptation. NDCs and National Adaptation Plans are drivers of integrated planning and have the potential to unlock vast investments, yet including targets for water is only a first step.

To drive global action, the Netherlands and the Republic of Tajikistan co-hosted the United Nations 2023 Water Conference, bringing the world together for a bold Water Action Agenda to accelerate change across sectors and deliver on the water actions in the 2030 Agenda for Sustainable Development and the Paris Agreement. To elevate the agenda’s emphasis on accelerating implementation and improved impact, the Netherlands is contributing an additional €5 million to the NDC Partnership to support countries to mitigate the impacts of climate change, reduce water-related climate vulnerability and increase public and private investments targeting water-nexus opportunities. As a global coalition of over 200 countries and international institutions, the NDC Partnership is uniquely positioned to support countries to enhance the integration of water in formulating, updating, financing and implementing countries’ NDCs.

One example showcasing the importance of incorporating water management into national planning comes from former NDC Partnership co-chair and climate leader, Jamaica. Jamaica’s National Water Commission (NWC), one of the largest electricity consumers in the country, mobilized technical assistance to develop an integrated energy efficiency and renewables program to reduce its energy intensity, building up the resilience of the network, while helping reduce the country’s greenhouse gas emissions. With additional support from the Netherlands, the International Renewable Energy Agency (IRENA) and the United Nations Development Programme (UNDP), together with Global Water Partnership (GWP)-Caribbean, the government of Jamaica will ensure the National Water Commission is well equipped for the future. Implementation of climate commitments and the requisite financing to do so are key to ensuring targets like these are met.

Water has the power to connect. The Netherlands is reaching out to the world.

Water has the power to connect. The Netherlands is reaching out to the world. We are committed to providing political leadership and deploying our know-how for a more water-secure world. As we look towards the outcomes of the Global Stocktake and COP28, it is essential that we make water the engine of climate action. 



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The state of the planet in 10 numbers

This article is part of the Road to COP special report, presented by SQM.

The COP28 climate summit comes at a critical moment for the planet. 

A summer that toppled heat records left a trail of disasters around the globe. The world may be just six years away from breaching the Paris Agreement’s temperature target of 1.5 degrees Celsius, setting the stage for much worse calamities to come. And governments are cutting their greenhouse gas pollution far too slowly to head off the problem — and haven’t coughed up the billions of dollars they promised to help poorer countries cope with the damage.

This year’s summit, which starts on Nov. 30 in Dubai, will conclude the first assessment of what countries have achieved since signing the Paris accord in 2015. 

The forgone conclusion: They’ve made some progress. But not enough. The real question is what they do in response.

To help understand the stakes, here’s a snapshot of the state of the planet — and global climate efforts — in 10 numbers. 

1.3 degrees Celsius

Global warming since the preindustrial era  

Human-caused greenhouse gas emissions have been driving global temperatures skyward since the 19th century, when the industrial revolution and the mass burning of fossil fuels began to affect the Earth’s climate. The world has already warmed by about 1.3 degrees Celsius, or 2.3 degrees Fahrenheit, and most of that warming has occurred since the 1970s. In the last 50 years, research suggests, global temperatures have risen at their fastest rate in at least 2,000 years.  

This past October concluded the Earth’s hottest 12-month span on record, a recent analysis found. And 2023 is virtually certain to be the hottest calendar year ever observed. It’s continuing a string of recent record-breakers — the world’s five hottest years on record have all occurred since 2015. 

Allowing warming to pass 2 degrees Celsius would tip the world into catastrophic changes, scientists have warned, including life-threatening heat extremes, worsening storms and wildfires, crop failures, accelerating sea level rise and existential threats to some coastal communities and small island nations. Eight years ago in Paris, nearly every nation on Earth agreed to strive to keep temperatures well below that threshold, and under a more ambitious 1.5-degree threshold if at all possible. 

But with just fractions of a degree to go, that target is swiftly approaching — and many experts say it’s already all but out of reach.

$4.3 trillion  

Global economic losses from climate disasters since 1970  

Climate-related disasters are worsening as temperatures rise. Heat waves are intensifying, tropical cyclones are strengthening, floods and droughts are growing more severe and wildfires are blazing bigger. Record-setting events struck all over the planet this year, a harbinger of new extremes to come. Scientists say such events will only accelerate as the world warms. 

Nearly 12,000 weather, climate and water-related disasters struck worldwide over the last five decades, the World Meteorological Organization reports. They’ve caused trillions of dollars in damage, and they’ve killed more than 2 million people.  

Ninety percent of these deaths have occurred in developing countries. Compared with wealthier nations, these countries have historically contributed little to the greenhouse gas emissions driving global warming – yet they disproportionately suffer the impacts of climate change.  

4.4 millimeters  

Annual rate of sea level rise

Global sea levels are rapidly rising as the ice sheets melt and the oceans warm and expand. Scientists estimate that they’re now rising by about 4.4 millimeters, or about 0.17 inches, each year – and that rate is accelerating, increasing by about 1 millimeter every decade.

Those sound like small numbers. They’re not.  

The world’s ice sheets and glaciers are losing a whopping 1.2 trillion tons of ice each year. Those losses are also speeding up, accelerating by at least 57 percent since the 1990s. Future sea level rise mainly depends on future ice melt, which depends on future greenhouse gas emissions. With extreme warming, global sea levels will likely rise as much as 3 feet by the end of this century, enough to swamp many coastal communities, threaten freshwater supplies and submerge some small island nations.  

Some places are more vulnerable than others. 

“Low-lying islands in the Pacific are on the frontlines of the fight against sea level rise,” said NASA sea level expert Benjamin Hamlington. “In the U.S., the Southeast and Gulf Coasts are experiencing some of the highest rates of sea level rise in the world and have very high future projections of sea level.”  

But in the long run, he added, “almost every coastline around the world is going to experience sea level rise and will feel impacts.”

Less than 6 years

When the world could breach the 1.5-degree threshold

The world is swiftly running out of time to meet its most ambitious international climate target: keeping global warming below 1.5 degrees Celsius. Humans can emit only another 250 billion metric tons of carbon dioxide and maintain at least even odds of meeting that goal, scientists say. 

That pollution threshold could arrive in as little as six years.

That’s the bottom line from at least two recent studies, one published in June and one in October. Humans are pouring about 40 billion tons of carbon dioxide into the atmosphere each year, with each ton eating into the margin of error.  

The size of that carbon buffer is smaller than previous estimates have suggested, indicating that time is running out even faster than expected.  

“While our research shows it is still physically possible for the world to remain below 1.5C, it’s difficult to see how that will stay the case for long,” said Robin Lamboll, a scientist at Imperial College London and lead author of the most recent study. “Unfortunately, net-zero dates for this target are rapidly approaching, without any sign that we are meeting them.”

43 percent 

How much greenhouse gas emissions must fall by 2030 to hit the temperature target

The world would have to undergo a stark transformation during this decade to have any hope of meeting the Paris Agreement’s ambitious 1.5-degree cap. 

In a nutshell, global greenhouse gas emissions have to fall 43 percent by 2030, and 60 percent by 2035, before reaching net-zero by mid-century, according to a U.N. report published in September on the progress the world has made since signing the Paris Agreement. That would give the world a 50 percent chance of limiting global warming to 1.5 degrees. 

But based on the climate pledges that countries have made to date, greenhouse gas emissions are likely to fall by just 2 percent this decade, according to a U.N. assessment published this month

Governments are “taking baby steps to avert the climate crisis,” U.N. climate chief Simon Stiell said in a statement this month. “This means COP28 must be a clear turning point.” 

$1 trillion a year 

Climate funding needs of developing countries

In many ways, U.N. climate summits are all about finance. Cutting industries’ carbon pollution, protecting communities from extreme weather, rebuilding after climate disasters — it all costs money. And developing countries, in particular, don’t have enough of it. 

As financing needs grow, pressure is mounting on richer nations such as the U.S. that have produced the bulk of planet-warming emissions to help developing countries cut their own pollution and adapt to a warmer world. They also face growing calls to pay for the destruction wrought by climate change, known as loss and damage in U.N.-speak. 

But the flow of money from rich to poor countries has slowed. In October, a pledging conference to replenish the U.N.’s Green Climate Fund raised only $9.3 billion, even less than the $10 billion that countries had promised last time. An overdue promise by developed countries to deliver $100 billion a year by 2020 to help developing countries reduce emissions and adapt to rising temperatures was “likely” met last year, the Organization for Economic Cooperation and Development said this month, while warning that adaptation finance had fallen by 14 percent in 2021. 

As a result, the gap between what developing countries need and how much money is flowing in their direction is growing. The OECD report said developing countries will need around $1 trillion a year for climate investments by 2025, “rising to roughly $2.4 trillion each year between 2026 and 2030.”

$7 trillion 

Worldwide fossil fuel subsidies in 2022

In stark contrast to the trickle of climate finance, fossil fuel subsidies have surged in recent years. In 2022, total spending on subsidies for oil, natural gas and coal reached a record $7 trillion, the International Monetary Fund said in August. That’s $2 trillion more than in 2020. 

Explicit subsidies — direct government support to reduce energy prices — more than doubled since 2020, to $1.3 trillion. But the majority of subsidies are implicit, representing the fact that governments don’t require fossil fuel companies to pay for the health and environmental damage that their products inflict on society. 

At the same time, countries continue pumping public and private money into fossil fuel production. This month, a U.N. report found that governments plan to produce more than twice the amount of fossil fuels in 2030 than would be consistent with the 1.5-degree target. 

66,000 square kilometers

Gross deforestation worldwide in 2022

At the COP26 climate summit two years ago in Glasgow, Scotland, nations committed to halting global deforestation by 2030. A total of 145 countries have signed the Glasgow Forest Declaration, representing more than 90 percent of global forest cover. 

Yet global action is still falling short of that target. The annual Forest Declaration Assessment, produced by a collection of research and civil society organizations, estimated that the world lost 66,000 square kilometers of forest last year, or about 25,000 square miles — a swath of territory slightly larger than West Virginia or Lithuania. Most of that loss came from tropical forests. 

Halting deforestation is a critical component of global climate action. The U.N.’s Intergovernmental Panel on Climate Change warns that collective contributions from agriculture, forestry and land use compose as much as 21 percent of global human-caused carbon emissions. Deforestation releases large volumes of carbon dioxide back into the atmosphere, and recent research suggests that carbon losses from tropical forests may have doubled since the early 2000s.  

Almost 1 billion tons

The annual carbon dioxide removal gap 

Given the world’s slow pace in reducing greenhouse gas pollution, scientists say a second approach is essential for slowing the Earth’s warming — removing carbon dioxide from the atmosphere.

The technology for doing this is largely untested at scale, and won’t be cheap.  

A landmark report on carbon dioxide removals led by the University of Oxford earlier this year found that keeping warming to 2 degrees Celsius or less would require countries to collectively remove an additional 0.96 billion tons of CO2-equivalent a year by 2030.

About 2 billion tons are now removed every year, but that is largely achieved through the natural absorption capacity of forests. 

Removing even more carbon will require countries to massively scale up carbon removal technologies, given the limited capacity of forests to absorb more carbon dioxide. 

Carbon removal technologies are in the spotlight at COP28, though some countries and companies want to use them to meet net-zero while continuing to burn fossil fuels. Scientists have been clear that carbon removal cannot be a substitute for steep emissions cuts. 

1,000 gigawatts 

Annual growth in renewable power capacity needed to keep 1.5 degrees in reach  

The shift from fossil fuels to renewables is underway, but the transition is still far too slow to meet the Paris Agreement targets. 

To keep 1.5 degrees within reach, the International Renewable Energy Agency estimates that the world needs to add 1,000 gigawatts in renewable energy capacity every year through 2030. By comparison, the United States’ entire utility-scale electricity-generation capacity was about 1,160 gigawatts last year, according to the Department of Energy.

Last year, countries added about 300 gigawatts, according to the agency’s latest World Energy Transitions Outlook published in June. 

That shortfall has prompted the EU and the climate summit’s host nation, the United Arab Emirates, to campaign for nations to sign up to a target to triple the world’s renewable capacity by 2030 at COP28, a goal also supported by the U.S. and China.

“The transition to clean energy is happening worldwide and it’s unstoppable,” International Energy Agency boss Fatih Birol said last month. “It’s not a question of ‘if’, it’s just a matter of ‘how soon’ – and the sooner the better for all of us.”

This article is part of the Road to COP special report, presented by SQM. The article is produced with full editorial independence by POLITICO reporters and editors. Learn more about editorial content presented by outside advertisers.



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Atopic dermatitis: Timely access is needed now

Moderate-to-severe atopic dermatitis (AD) is not just an itch and may not just go away on its own.

It is neither a small rash nor just some dry skin, and it doesn’t only impact children.

The fact of the matter is that one in three pediatric AD patients have moderate-to-severe disease. Not all will outgrow their AD; those that don’t face a lifetime of disruptive symptoms. A lifetime of intense itching, redness, inflammation and discomfort can have a profound impact on an individual’s physical and emotional well-being.

Misunderstandings about the complex nature of the condition means that AD is often managed with less-than-optimal outcomes. However, too many people require more than just topical and anti-inflammatory treatment. In fact, millions who live with moderate-to-severe AD without the necessary treatment experience lifelong implications, impacting life events such as education, career, marriage and personal family decisions.

Furthermore, AD has implications beyond the individuals living with it. Being a caregiver for someone living with AD can have substantial mental, physical and financial consequences. For example, research has shown that parents can spend approximately 22 hours a week applying any treatment they can find for their children – including moisturizers, wet wraps or bleach baths – to alleviate painful, chronic, debilitating flare-ups of inflamed, raw and bleeding skin.

Ensuring children with AD and their caregivers have appropriate access to effective treatment can be vital to address the frustrating, inefficient and recurring cycle of time-consuming visits to general practitioners.

Ensuring children with AD and their caregivers have appropriate access to effective treatment can be vital to address the frustrating, inefficient and recurring cycle of time-consuming visits to general practitioners to try and manage symptoms and stop chronic flare-ups. Importantly, this approach would not only improve health outcomes, but it could also positively impact AD patients and their families.

Impact of AD is beyond the visible and the individual

While it is easy to think of AD as a skin disease, the lifetime impact of the condition on a person is more than what people see.

While it is easy to think of AD as a skin disease, the lifetime impact of the condition on a person is more than what people see.

For instance, missing school and social activities can become a normal occurrence for children with severe AD. Their daily routine is frequently overshadowed by appointments, treatments and flare-ups, as well as the emotional burden of shame and low self-confidence about their physical appearance. This burden results in some children struggling to keep up with their peers, which has a bearing on their quality of life and their educational and social development. A study has shown that 12.5% of children under three who have severe AD experience developmental delays in motor skills, communication, relationships and play.

An often-overlooked aspect of living with AD is that the condition can lead to significant sleep disturbances, often caused by persistent itching.

“Sleep is a huge factor that’s affected by AD and lack of sleep affects every aspect of your life. It doesn’t allow you to concentrate in school if you’re sleep deprived [and] you’re definitely more moody,” explained Dr. Patrick Finklea, a pediatrician and parent of a child living with AD.

As children get older, AD-associated issues broaden the gap with their peers, leading to increased social difficulties, isolation and a significant mental health impact. According to a survey from the National Eczema Association, 20% of parents say that their child is bullied at school because of their eczema (including AD, the most common form of the condition) and 75% highlight that their child experienced lower self-esteem as a result.

In addition to the physical and emotional strain on caregivers, the financial burden of attempting to alleviate a child’s chronic symptoms, arising from lifestyle adjustments, lost wages and out-of-pocket costs, are substantial. Caregivers may also have to consider a career change or give up work altogether due to the demands of looking after someone with AD.

Act now to ensure a brighter future

It is vital to stop thinking about AD as a childhood issue – one that will be outgrown. Instead, it needs to be prioritized as a serious lifelong condition and recognized as a chronic and debilitating disease with lasting and profound impacts.

It is vital to stop thinking about AD as a childhood issue – one that will be outgrown. Instead, it needs to be prioritized as a serious lifelong condition and recognized as a chronic and debilitating disease with lasting and profound impacts; a disease that not only affects the individual but also the social ecosystem.

In Europe alone, the total direct cost to society associated with moderate-to-severe AD is estimated at €30B annually.

Given the substantial individual and societal costs of AD, decision-makers need to urgently implement an effective response to meet the needs of patients. In Europe alone, the total direct cost to society associated with moderate-to-severe AD is estimated at €30B annually. Therefore, prioritizing investment in early and effective AD interventions – including timely access to specialists and effective treatments – can have significant impacts on the overall cost and outcomes of disease management.

As MEP Sirpa Pietikäinen (EPP, Finland) said at a POLITICO Spotlight debate last year, “Countries always reimburse the cheapest drug on the market, then the next cheapest, then the next one. This ladder approach is wasting money and enabling the condition of the patient to deteriorate so much they can’t recuperate.”

We call on decision makers to implement evidence-based policies to improve access to care and prioritize timely intervention to manage AD – all with the aim to advance the health and well-being of individuals and contribute to the long-term economic and social prosperity of society.

MAT-GLB-2305184 V1.0 | October 2023



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Britain’s COVID-19 inquiry exposes the rot at the heart of Whitehall

LONDON — Everyone knew the British state had problems. This week revealed just how deep the rot goes.

Britain’s public inquiry into the handling of the COVID-19 pandemic stepped up a gear this week, with a procession of key witnesses taking the stand who were at the heart of the U.K. government in 2020.

The punchy oral testimony — and sweary WhatsApp messages — of Dominic Cummings, the former No. 10 Downing Street adviser turned arch enemy of Boris Johnson, grabbed all the headlines, as he attacked his old boss while struggling to account for his own crude and abusive language.

But it was Cummings’ long, incisive written statement to the inquiry, along with the testimony of a former top civil servant, Helen MacNamara, which contained the starkest home truths for the British state.

“I think we are absolutely fucked. I think the country is heading for a disaster. I think we are going to kill thousands,” MacNamara was revealed to have told colleagues in March 2020, as coronavirus began to grip the U.K.

Those words, from the-then second most powerful civil servant in the country, came as she and other senior officials abruptly realized the U.K. government had no real plan to deal with a global pandemic of that nature — despite years of confident reassurances to the contrary.

“I have just been talking to the [U.K. government] official Mark Sweeney, who is in charge of coordinating with the Department for Health,” MacNamara recalled saying. “He said — ‘I have been told for years that there is a whole plan for this. There is no plan.’ We are in huge trouble.”

What followed that dawning realization was an intense period of chaos, as ministers and officials grappled with never-before-considered questions such as whether to ban people from meeting their loved ones, and whether to place Britain into a strict lockdown.

Fingers are now being pointed at both individuals and wider systems for all that went wrong.

The blame game

Unsurprisingly, Britain’s ex-Prime Minister Boris Johnson has taken his fair share of criticism this week.

“It was the wrong crisis for this prime minister’s skillset,” Lee Cain, Johnson’s former director of communications, said in his evidence Tuesday. Others were less diplomatic — including Cain himself, in private WhatsApp messages handed to the inquiry by ex-colleagues.

In one such WhatsApp exchange, Cummings and Cain — old friends from the 2016 ‘Vote Leave’ campaign — detailed how they found Johnson “exhausting” to work with due to his lurches back and forth on key policy decisions.

“Pretty much everyone calls him ‘the trolley’,” Cummings told the inquiry, referring to a disparaging nickname he invented for Johnson due to the ex-PM’s inability to hold a clear line.

But beyond the Boris-bashing, Cummings and other ex-officials focused their ire on the broader state of Britain’s governing systems, rather than bungling individuals at its centre.

Cummings described the all-important Cabinet Office department — responsible for organizing the business of government and linking different departments together — as a “bombsite” and a “dumpster fire,” with a “huge problem of quality control … inconsistent data, inconsistent facts.”

This disorganization had consequences.

On March 16, 2020, Cummings said he received an email from a senior official warning that the Cabinet Office had yet to see any real plans for the pandemic from government departments — “never mind evaluated and fixed them,” he said. The virus had been in the U.K. for almost three months.

“[The Cabinet Office] cannot drive priorities or fix problems with departments,” Cummings wrote.

What became clear over the course of this week was that the British government was slow to take the virus seriously in early 2020 and even slower at figuring out a coherent and consistent plan to deal with it, jumping back and forth between early efforts aimed at pursuing herd immunity — until it became clear such an approach would be catastrophic.

“There are many signs that the way the Cabinet Office works was extremely ill-suited to this crisis,” Giles Wilkes, a former No. 10 adviser and senior fellow at the Institute for Government think tank, told POLITICO.

“It is very good for bringing together the people needed to avoid rows blowing up the government. In our system that is really valuable. But from [Cummings’] very compelling account, it was not brilliantly set up to be the body that focusses the PM and his power on a rapidly changing, dangerous situation,” Wilkes added.

‘Toxic’ culture

MacNamara, second in command in the Cabinet Office at the time, drew similarly damning conclusions.

She described how the British government “moved up the gears more slowly than the pace of the crisis,” and remained fixated on standard day-to-day government business as the pandemic began to rage.

She also lambasted the culture at the heart of government — arguing a “macho” and “toxic” environment fostered by a largely male leadership team hampered the broader response.

She said female experts were ignored, and senior women in government “looked over.” She pointed to a lack of consideration of childcare during school closures, and of the impact of lockdown restrictions upon victims of domestic violence, as examples of policy areas that suffered due to a lack of a “female perspective” inside government.

One result of that toxic environment saw MacNamara herself targeted by Cummings with misogynistic language in a WhatsApp message to a colleague revealed by the inquiry. She said she was “disappointed” Johnson didn’t do more to keep his top adviser in check.

Britain’s current top brass are pushing back, at least a little. Speaking Thursday, U.K. Science Secretary Michelle Donelan insisted she did not recognize MacNamara’s account of the culture inside government.

Coming attractions

Cummings has argued — including in multiple tweets since his evidence session ended — that observers should focus on his arguments about the broader failures of the system.

But it is the failings of one particular individual, Johnson, who was ultimately responsible for directing the government, which will continue to be scrutinized in the months ahead.

“If the PM at the heart of this is not a functional entity, cannot make a decision, has fundamentally poor judgment or lack of attention, then it doesn’t matter if the system around him is brilliant or rubbish. Things will go awry when they reach his desk,” Wilkes told POLITICO.

“The central role of the PM, and his rubbishness, cannot be evaded.”

Johnson’s former Health Secretary Matt Hancock has also come under intense fire this week, for his role in the lack of apparent planning for a pandemic, his handling of testing targets, and the crisis in British care homes as COVID-19 hit.

Both MacNamara and Cummings accused Hancock of telling falsehoods during the pandemic — or, in MacNamara’s case, she agreed he had a habit of “regularly telling people things that they later discovered weren’t true.”

Johnson’s successor-but-one as prime minister, Rishi Sunak — who was U.K. chancellor during the pandemic — also has questions to answer. He will likely face particular scrutiny for his now-infamous “eat out to help out” scheme — a government-sponsored discount to encourage diners back into restaurants in the summer of 2020 — which some medical experts believe helped spread the virus.

Conveniently enough, all three men — Johnson, Sunak and Hancock — are slated to appear before the inquiry in the same week at the end of November, two people with knowledge of the inquiry told POLITICO.

All of Westminster is holding its breath.



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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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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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Labs: the (overlooked) building block of Universal Health Coverage

Hepatitis C (HCV) — a potentially life-threatening virus that infects 1.5 million new people around the world every year — is highly treatable if diagnosed early.[1]

Unfortunately,  access to quality screening is far from universal. Countries like Egypt — one of the countries with the highest prevalence of HCV in the world — demonstrate the impact screening can have. In 2015, HCV was prevalent in an estimated 7 percent of the country’s population and accounted for 7.6 percent of the country’s mortality, presenting a significant health care and societal burden.[2]

But since then, Egypt has turned a corner. In 2018, the Egyptian Ministry of Health and Population launched a massive nationwide HCV screening and treatment campaign as part of its 2014-2018 HCV action plan.[3] The campaign’s results were inspiring: by July 2020, Egypt had screened more than 60 million people[3] and treated 4 million residents.[2] Today, Egypt is set to be the world’s first country to eliminate HCV within its borders.[2]

The results of Egypt’s HCV screening program speak to diagnostics’ power in contributing to improved health outcomes around the world. Among the essential components of any health system is the capacity for prevention, which includes timely screening and detection. But a preventive approach based on timely diagnosis won’t work without the right infrastructure in place.

Strong laboratories as a cornerstone of building better health care

Matt Sause, CEO Roche Diagnostics | via Roche

The World Health Organization (WHO) highlights the critical role well-functioning laboratory services play in health systems with good reason.[4] Around the world, clinicians increasingly rely on  laboratory tests for diagnostic and treatment decisions. These tests help them make more informed decisions that result in better care and potentially improved outcomes for patients.

The challenges facing labs today — and tomorrow

Two key challenges facing laboratory systems today are underfunding and insufficient resources. Despite their central importance, laboratories struggle to garner the political and financial support they need to be as effective as possible. For example, it’s estimated that while lab results drive approximately 70 percent of clinical decision making, laboratories make up only 5 percent of hospital costs.[5]

After all, it’s the health care systems with strong, resilient labs that will be best placed to manage future pandemics and ever-growing health threats like heart disease and dementia.

What’s needed is a political commitment to provide everyone with access to accurate and timely diagnosis that paves the way to effective treatment and health. And putting this commitment into practice can only be achieved and sustained through coordinated multistakeholder efforts and public—private partnerships. This is not just a worthwhile investment for patients, but also the wider health care system in the long run. After all, it’s the health care systems with strong, resilient labs that will be best placed to manage future pandemics and ever-growing health threats like heart disease and dementia.

Another challenge is the health care workforce. Effective use of diagnostics requires qualified people to drive it, with expertise in pathology and laboratory medicine. Yet the world currently faces a laboratory staffing shortage. For diagnostics in particular, baccalaureate degree programs in laboratory science have previously been on the ‘endangered list’ of allied health professions.[6] In the end, inadequately trained staff, frequent turnover and scheduling problems all make quality lab results more difficult to guarantee.

This UHC ambition is only possible when backed by a network of strong laboratories that help ensure individuals can access high-quality diagnostics services without financial burden in all health care systems.

And that’s not all: inadequate infrastructure and staffing shortages are more present in low-income, rural communities, which exacerbate the broader diagnostics gap troubling global health care today. Many low-income countries lack an integrated laboratory network that can fully provide high-quality, accessible and efficient laboratory testing services for the entire population. In fact, a commission convened by The Lancet concluded that 81 percent of these populations have little or no access to diagnostics.[7]

The path to Universal Health Coverage

Put simply, innovative diagnostics are only meaningful if they reach people where and when they’re needed. Advancing this equity is at the heart of the WHO’s vision for Universal Health Coverage (UHC) by 2030. The goal? To guarantee all people have access to high-quality services for their health and the health of their families and communities, without facing financial hardship.

This UHC ambition is only possible when backed by a network of strong laboratories that help ensure individuals can access high-quality diagnostics services without financial burden in all health care systems. To do this, UHC should explicitly include diagnostics services. Financially, it’s savings from screening, early diagnosis and targeted treatment that make UHC feasible. Health care systems will have to undergo a systemic shift from focusing on treatment to focusing on prevention. And that’s just not possible when clinicians don’t have access to fast, accurate and cost-efficient lab results to inform their clinical decision-making. Policies and regulations that safeguard UHC goals of access and health equity are essential to make progress toward UHC.[8] The Saving Access to Laboratory Services Act (SALSA), in the United States, is an example of how national policies can help to ensure sustainable laboratory networks and contribute to equitable access to essential healthcare.

Stronger labs can not only help health care systems make savings in the routine management of population health; investing in them also helps to reduce costs and prepare in advance for any future public health crises.

This year has already seen encouraging progress toward achieving UHC through enhanced diagnostics capacity. The adoption of the resolution on strengthening diagnostics capacity at the World Health Assembly in May was an important signal of growing international political support for diagnostics. It was also a call to action. The next step for this month’s United Nations General Assembly and Sustainable Development Goals (SDG) Summit is channeling political support for diagnostics into the development of an action-oriented declaration.

To put us closer to UHC, this declaration should commit to ensuring that national health plans include access to timely detection and prevention. That starts with supporting laboratory systems and establishing National Essential Diagnostics Lists that identify the most critical diagnostic tests to help diagnose patients quickly and accurately so that they can receive needed treatment. At Roche, we’re advocating that governments, industry, civil society and other policy stakeholders will come together around concrete plans and shared resources that strengthen diagnostics and the lab infrastructure that makes them effective. In line with our commitment to increase patient access to important diagnostic solutions by 2030, we plan to do our part.


[1] Hepatitis C. World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/hepatitis-c (Accessed 22.08.2023)

[2] Egypt’s Ambitious Strategy to Eliminate Hepatitis C Virus: A Case Study. Hassanin, A. et al. Available at:   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087425/ (Accessed 22.08.2023)

[3] Hepatitis C in Egypt – Past, Present, and Future. Roche Diagnostics. Available at: https://diagnostics.roche.com/global/en/article-listing/egypt-s-road-to-eliminating-hepatitis-c-virus-infection—a-stor.html (Accessed 22.08.2023)

[4] Monitoring the Building Blocks of Health Systems. World Health Organization. Available at: https://apps.who.int/iris/bitstream/handle/10665/258734/9789241564052-eng.pdf (Accessed 14.07.2023)

[5] The Cost-effective Laboratory: Implementation of Economic Evaluation of Laboratory Testing. Bogavac-Stanojevic N. & Jelic-Ivanovic Z. J Med Biochem. Volume 36, Issue 3, 238 – 242. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287218/

[6] Ensuring Quality Cancer Care through the Oncology Workforce: Sustaining Care in the 21st Century: Workshop Summary. National Academy of Sciences. Available at: https://www.ncbi.nlm.nih.gov/books/NBK215247/ (Accessed 14.07.2023)

[7] Essential diagnostics: mind the gap. The Lancet Global Health. Available at: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00467-8/fulltext (Accessed 14.07.2023)

[8] Private Sector Commitments To Universal Health Coverage. UHC Private Sector Constituency 2023 Statement. https://www.uhc2030.org/fileadmin/uploads/UHC2030_Private_Sector_Commitments_Statement_April2023.pdf (Accessed 29.08.2023)



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Meet the New Conservatives giving Rishi Sunak a migration headache

LONDON — Watch out Rishi Sunak, there’s a new right-wing Tory pressure group in town.

The New Conservatives — a group of 25 MPs from the 2017 and 2019 parliamentary intakes — launched Monday with a headline-grabbing call for the Tory prime minister to do more to cut migration.

They’re urging Sunak — already under pressure over the issue — to focus on meeting his predecessor-but-one Boris Johnson’s 2019 manifesto pledge to get net numbers to below 226,000. So who are the New Conservatives? And what exactly do they want?

The new group is run by Danny Kruger, a former aide to Johnson, and Miriam Cates, a backer of Home Secretary Suella Braverman when she ran for the Tory leadership last year.

Other members of the group include backbenchers Tom Hunt, Jonathan Gullis, Gareth Bacon, Duncan Kaker, Paul Bristow, Brendan Clarke-Smith, James Daly, Anna Firth, Nick Fletcher, Chris Green, Eddie Hughes, Mark Jenkinson, Andrew Lewer, Marco Longhi, Robin Millar, and Lia Nici.

Lee Anderson, the pugnacious former Labour aide turned Tory deputy chairman, was conspicuously absent from the event — and all literature — despite being part of the group and billed to speak right up until late last night. Stand-in Kruger insisted “he’s unwell in bed” but also “doesn’t officially endorse policy proposals” due to his party role.

Eagle-eyed readers will note that this list does not tot up to the advertised 25.

When asked about this at the press conference, Hunt said there were a “wide group of MPs who are supportive of our work,” but that those listed are the ones specifically endorsing the migration policies presented today.

So what do they want?

Cates kicked off the group’s launch event in Westminster by making it pretty clear that the group’s immediate focus is on migration — though there’s clearly plenty more to come.

Her message to Sunak? “The choice is this: cut immigration, keep our promise to voters, and restore democratic, cultural and economic security, or kick the can down the road, lose the next election, and resign ourselves to a low growth, low-wage, labor-intensive service economy with a population forecast to rise by another 20 million in the next 25 years.”

The New Conservatives outlined a 12-point-plan Monday that they claim will do just that. But some of its key recommendations are likely to prove contentious.

Perhaps the most headline-grabbing point is a call to scrap Health and Care Visas, launched to fill gaps in the health and social care sector with overseas workers. The group says this will cut the number of new visas issued by 117,000 and reduce long-term international migration by 82,000.

But big questions remain over exactly how the resultant gaps in the health and social care workforce would be filled with British recruits. UNISON general secretary Christina McAnea said the government has “done nothing to solve the growing crisis in care. Now a group of its MPs want ministers to make things a whole lot worse.”

Beyond that pledge, the New Conservatives also want to reserve university study visas for only the “brightest” international students; stop overseas graduates staying for up to two years in the U.K. without a job; and place stricter limits on social housing being allocated to migrants.

They also want to “rapidly implement” the government’s Illegal Migration Bill, which — given its mauling in the House of Lords Monday — may be a tough ask.

Are they rivals to Rishi?

The group sternly rejects the notion that they’re here to cause trouble for the prime minister, with Daly telling assembled journalists Monday that he’s “depressed” by questions of rivalry.

Just to hammer the point home, Daly added that “every single person here today supports the prime minister.”

But they’re undoubtedly a thorn in Sunak’s side as the next election looms.

The prime minister’s official spokesperson insisted Monday that the government’s plans on migration don’t need toughening up. “We have to strike the right balance between tackling net migration and taking the people we need,” the spokesperson said, adding “we believe they strike the right balance currently. We keep our migration policies under review.”

Is this just about migration?

So far — but expect to hear plenty more from the group in the coming months.

Speaking to POLITICO, Hunt said he sees the group focusing on three main issues: migration; law and order; and what they see as the threat to Britain from “woke” ideas.

Hunt stressed that he wants the outfit to be “dipping their toes” into anti-woke issues “generally as a push-back, rather than waking up every morning and thinking ‘right, what’s our next big culture war wedge issue?’” So expect some anti-woke seasoning sprinkled on the New Conservatives’ main course.

Hunt says he’s animated by what he sees as “wokeness” in schools, and a preponderance of “self-loathing in this country.”

“I get concerned when I see the odd poll that says the majority of 18-25-year-olds see Churchill as a villain rather than a hero,” he said. That doesn’t mean the group will call for Britain to start “glossing over the past and saying we’ve always got it right,” he added — but recognizing that “in a struggle of Russia and China, we’re a damn sight better than them.”

So will this agenda help the Tories win in 2024 — or recover afterwards?

Polls suggest the Tories are on course to lose the next election, and badly. The New Conservatives want their ideas featured in the 2024 election manifesto, and believe they have the agenda to connect with working-class voters in the so-called Red Wall seats Johnson snatched from Labour in 2019 and which now look vulnerable.

Cates told the audience gathered in Westminster Monday that: “We want to win, of course we do, but it’s more than that. It’s because we believe that we still have, despite everything, the best chance of delivering for the British people.” She said of the party’s 2019 platform: “The demand for that offer is still there. We want to fulfill it.”

Not all Tories are convinced. Conservative commentator John Oxley argued that the New Conservatives’ impact may be short-lived.

It is, he said, “dominated by the sort of 2019, Red Wall MPs who are very likely to lose their seats next time around. They may be trying to sway the manifesto in a way that helps them, or mark themselves out as immigration hardliners to try and buck the national trend, but it seems unlikely to have much sway with Rishi Sunak.”

And he warned: “Equally, it seems unlikely this group will have much impact on the future of the Conservative Party, as so many of them will be out of parliament when that discussion begins after the election.”

Dan Bloom contributed reporting.



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