Why are the board chairs of AstraZeneca, GSK, Novo, Novartis, Roche, Sanofi, Boehringer Ingelheim, Chiesi and Ipsen warning that Europe’s pharmaceutical industry faces a “slow agony” amid competition from the U.S. and China, what evidence do they cite—including delayed or unavail

The chairs argue that Europe risks a self-reinforcing decline: constrained medicine budgets, slow and fragmented reimbursement, weaker incentives and slower trials reduce patient access and make the region less attractive for R&D, trials and manufacturing—while the US and China are drawing investment at scale. “Slow agony” is Mario Draghi’s warning, adopted in their open letter, rather than a claim that Europe’s industry has already collapsed. 5

• Evidence they cite

  • Europe’s global share of pharmaceutical R&D fell from 43% in 1990 to 31% and is still declining; its share of commercial clinical trials halved over a decade to 9%. The letter says China has passed Europe in trials, pharma patents and development of new medicines. 5
  • More than $600 billion of pharmaceutical investment was announced in the US and China over the preceding two years, according to the chairs. 5
  • They say roughly 40% of newly approved therapies never reach European patients and that patients wait nearly 600 days for those that do. EFPIA’s latest access survey similarly reported a 532-day median across 168 centrally authorised medicines, ranging from 56 days in Germany to 1,201 in Romania. 513
  • Prior warnings have become more concrete: Reuters reported delayed European launches and a 35% fall in new-drug launches, while companies had warned that they could reduce investment or defer launches if pricing conditions did not improve. 21
  • Their core diagnosis is that European systems treat medicines chiefly as a cost to suppress: fixed or arbitrary medicine budgets, inflation-unadjusted spending and reimbursement systems that underrecognise broader benefits such as avoided hospitalisations and healthier working lives. 5

• What they want national governments to do

  • Increase and protect spending on innovative medicines, treating them as strategic health infrastructure rather than a discretionary cost. 5
  • Modernise health-technology assessment, pricing and reimbursement so that decisions are faster and reflect total patient, health-system and economic value—not merely the drug acquisition price. 5
  • Reduce country-to-country delays and improve diagnosis, prevention and uptake of guideline-recommended care. 5

• What they want from the EU

  • Accelerate and simplify end-to-end clinical-trial processes. 5
  • Maintain strong, predictable intellectual-property protection, alongside pragmatic digital rules. 5
  • Give member states greater fiscal flexibility to invest in health and innovative medicines, on the premise that returns accrue over years rather than within an annual budget cycle. 5

• Why Germany is central to the dispute

  • Germany’s 2026 health-insurance cost-containment reform received final approval despite industry objections that it would deter investment. 2
  • The reform more than doubled the mandatory manufacturer rebate on most branded prescription medicines, from 7% to 15.5%, according to reporting on the legislation. This illustrates the conflict: governments face immediate insurance-budget pressures, whereas manufacturers say additional rebates and price controls weaken expected returns and therefore investment incentives. 2

• Potential upside claimed

  • The chairs estimate that closing Europe’s clinical-trial gap with China and the US could unlock €53 billion and 82,000 jobs. This is an industry-backed economic estimate, not a guaranteed outcome; it depends on Europe actually winning additional trials and retaining the related R&D, hospital and supply-chain activity. 5

The policy trade-off is therefore real: higher and faster payment for valuable medicines could strengthen access and investment, but it raises short-term public-health spending and requires credible assessment of clinical value. The companies’ evidence strongly supports a relative competitive decline and access delays, while their proposed spending and IP changes remain policy prescriptions rather than independently proven solutions.