During a high-stakes meeting with party chairs in Strasbourg on Tuesday, von der Leyen said that payments to regions — which currently make up a third of the EU’s multi-year budget — will continue to be handed out to local authorities as opposed to national governments in the new budget, two people in the room told POLITICO.

Von der Leyen’s offer, however, was not enough to quell concerns from the Socialists and Democrats, who have been increasingly critical of her leadership in recent weeks.

“We missed clarity and commitment … If nothing changes, it will be difficult for the S&D to decide not to abstain on Thursday,” a spokesperson for the group told POLITICO after Tuesday’s meeting.

Von der Leyen is expected to survive the vote even if the Socialist and Liberal parliamentary groups abstain, as the motion would need a two-thirds majority in Parliament to pass. But it would send a strong message that she can’t count on Parliament to back her unconditionally.

The Socialists, the second-largest group in the European Parliament, are linking their support to the preservation of the European Social Fund, which is supposed to tackle poverty and support vulnerable groups.

Commissioner for social rights Roxana Mînzatu, herself a Socialist, is leading a push inside the EU executive to save the fund.

Von der Leyen spoke first, before heads of political groups took the floor. Here are some things we noticed.

1. Von der Leyen’s coalition is in disarray

In fact, at this point we are even doubting whether to keep calling it a coalition. (It’s never been formal, of course, simply the group of centrist parties that supported her and keep her afloat.)

As the debate went on, she got slap after slap from Socialists, Greens, and the liberals of Renew.

Between them they didn’t like her decision to drive a deregulation agenda targeting last term’s Green Deal, criticized the way she bypasses the Parliament to pass measures such as billions of euros in loans for defense spending, and as Socialists chief Iratxe García put it, “for looking the other way” when her own center-right European People’s Party does deals with the far-right.

2. She’s not afraid of dishing out low blows to critics

Von der Leyen didn’t stop at picking apart her opponent’s arguments. She came with knives out: Calling out fake news, talking about “the oldest playbook of extremists” and branding her critics “conspiracists,” “anti-vaxxers” and “Putin apologists.”

3. In fact, she’s partial to showing a bit of sass

Occasions are few when you get to see the 66-year-old politician really attack her political opponents.

The confidence vote stems from frustration at von der Leyen’s undisclosed communications with the CEO of vaccine-maker Pfizer during the pandemic. Speaking in Strasbourg this week she dismissed the accusations, warning of an “alarming threat from extremist parties trying to polarize societies through disinformation.”

In a second post on Wednesday, Orbán framed the vote as a defining moment for Europe.

“Tomorrow will be a turbulent day in the European Parliament,” he wrote. “The vote was scheduled due to the corruption scandals piling up around the President, but we all know that corruption is just the tip of the iceberg. This is about competence, results, and the future of Europe.”

Orbán’s attack came just a day after the Commission issued country-specific economic recommendations, urging Hungary to adopt “permanent” fiscal measures to address a budget gap.

The Hungarian government pushed back, defending its economic strategy. “In contrast to Brussels, for the government the families and pensioners and Hungarian companies come first, not the multinationals,” Hungary’s economy ministry said in a statement Wednesday.

Budapest and Brussels have been locked in a broader dispute for years, with the EU freezing billions of euros in funds over rule-of-law concerns. With less than a year until Hungary’s next national election, Orbán has intensified his campaign against the EU — with von der Leyen and the bloc’s support for Ukraine chief among his targets.

But for Mexico, facing Trump’s threats to impose 25 percent tariffs across the board along with Canada, there was no reason to shout news of the EU accord from the rooftops.

Trump last Saturday issued an order to hit Mexico with those tariffs, affecting imports worth $500 billion, only to suspend them on Monday for 30 days. Economists at EY estimate that, if they enter force, they would cause Mexico’s economy to shrink by 1.6 percent this year and by 4.5 percent in 2026, with inflation rising due to a weaker peso and higher import costs.

“Trade relations with the United States are already tense, and perhaps announcing a Mexico-EU deal in January would not have been well received,” said Cesar Guerra, Mexico’s former chief negotiator on the EU deal. Guerra now represents MexChamEU, a business group, which he said was “pleased with the conclusion of the negotiations.”

Despite the commotion across the pond, Šefčovič has defended the decision to make the announcements on the deal right before Trump took office. Speaking to European lawmakers last Wednesday, he said that the EU “had to seize the momentum, take a chance, and go for it.”

Silence is golden

Carlos Mota, a senior economic journalist, confirmed the fears in Mexico City over Trump’s resolve to reassert U.S. dominance in global trade and eradicate the structural trade deficit — even at the expense of its closest trading partners.

“The Mexican government does not want to announce or celebrate it because of potential U.S. tariffs. Here in Mexico, European diplomats are very puzzled about this,” Mota, a columnist for El Heraldo de Mexico, told POLITICO before Trump’s weekend tariff order.

Approximately, one in every 10 adults in Europe is affected by chronic kidney disease , yet most are unaware they have it. Many might find out too late.(1)

If caught early, CKD can be manageable. Left untreated, it progresses toward kidney failure — a complex, life-threatening condition that cannot be reversed.(2) Despite the severity of the disease, it is underdiagnosed and often overlooked in European public health policies.(2)

If caught early, CKD can be manageable. Left untreated, it progresses toward kidney failure.

Even so, there is hope that Europe can change the course of the growing CKD epidemic. The solution is simple and cost-effective: Implement policies prioritizing early screening for high-risk patients and treatments according to guidelines.(3,4)

CKD’s extensive impact

CKD involves the gradual loss of kidney function, which disrupts the body’s critical systems. It often progresses without symptoms until the later stages — at which point it may be that only a third or less of kidney function remains.(2,5,6)

In Europe, an estimated 100 million adults live with CKD, with another 300 million at risk.

Reduced kidney function can be detected early with simple urine and blood tests.(7) But these tests are underutilized, even for high-risk CKD patients — such as those with diabetes. This may be partly because kidney health is not prioritized in public health policies.(8) For instance, despite kidney disease affecting an estimated 850 million people globally(9) and CKD being projected as the fifth leading cause of death by 2040,(3) CKD is still not recognized by the World Health Organization as a priority non-communicable disease, neither is it highlighted in the 2022-2027 EU Non-Communicable Diseases Initiative ”Healthier Together”.(10,11)

In Europe, an estimated 100 million adults live with CKD, with another 300 million at risk.(12) Alarmingly, global stats estimate fewer than 10 percent of the affected know they have the disease.(13)

The impact of CKD extends beyond physical health. Nearly a third of CKD patients in stage 3 to 5 experience anxiety or depression, and treatments such as dialysis and kidney transplants are invasive and life-altering.(14,15) Later stages of the disease can also take a heavy toll on families, who often face financial strain and disruptions to daily life while caring for loved ones.(2)

For health care systems, the costs are staggering. Europe allocates approximately €140 billion annually to CKD and kidney failure.(4) In many high-income countries, end-stage CKD accounts for 2 to 3 percent of health care budgets, despite affecting just 0.03 percent of the population.(16)

But there is also an environmental price we pay for the treatment of late stage CKD, with dialysis being one of the most resource-intensive medical fields.(17) If current trends persist, projections indicate that by 2032, CKD-related environmental burden in Germany alone could generate approximately 1.24 billion kilograms of carbon emissions — equivalent to the annual carbon footprint of 737,000 cars.(18)

As Europe’s population ages, the prevalence of CKD is expected to rise dramatically, placing even greater pressure on health care systems.(19) Dr Navdeep Tangri, chair of the Medical Advisory Council for the Global Patient Alliance for Kidney Health, a professor of medicine at the University of Manitoba and senior scientist at the Chronic Disease Innovation Centre, warns of the dire consequences of inaction.

“We know, even counting in today’s standards, that globally there has been a 33 percent rise in the prevalence of CKD from 1990 to now(20), and there is a projected 116 percent rise in mortality from chronic kidney disease between 2019 and 2040,” he says. (21,22) “Those numbers tell the story of a billion-person, trillion-dollar disease.”

The case for early detection

Despite CKD’s widespread impact, it can be a solvable problem — if caught early.

The health benefits of optimized treatment according to guidelines are clear.(23) Preliminary results from a recent study found that CKD patients (the majority of whom were in mid-to-late stages of the disease) who were prescribed and adhered to guideline-recommended therapies (kidney-protective medication) lowered their risk of death by 67 percent and hospitalization by 20 percent.(23)

And, economically, early detection and treatment are particularly cost-effective because treatments and procedures become more expensive as the disease advances.(3) Around 250,000 Europeans rely on dialysis to survive — a number rising by 5 to 8 percent annually.(24) The cost of haemodialysis to health care systems can reach an eye-watering €80,000 per patient per year.(25) By contrast, early diagnosis and treatment allow for lower-cost interventions that can slow progression, reduce complications, preserve quality of life and significantly ease the burden on health systems.(2)

A need for more efficient programs and policies

Although international guidelines recommend regular CKD screening for at-risk individuals (those with diabetes and hypertension),(26) few European countries have adopted targeted screening programs. Among those that do have them, their implementation remains inconsistent, and many patients do not receive immediate access to guideline-recommended therapy even when diagnosed.(2) A lack of CKD-specific training for primary care providers and inadequate referral pathways further hinder Europe’s patient outcomes.(2)

Take Germany: while it can be applauded for incorporating international CKD guidelines into its national health care system, the reality is that adherence to recommended testing and care pathways remains low.(27) And in France, where the care of patients with end-stage-kidney disease is estimated to cost €5 billion by 2025,(28) significant gaps persist between clinical guidelines and actual practice.(29)

“France recommended screening for people over 60 since 2012.(30) That was adjusted in 2021 to include individuals of any age at risk,”(31) explains Yvanie Caillé, Founder of the French patient advocacy group Renaloo. “But uptake is still low.”(32)

Political momentum is building

These shortcomings in testing and care pathways leave significant room for policy to make improvements.

Caillé remains hopeful, pointing to recent policies that might encourage more testing. “The French Health Insurance has made CKD one of its strategic priorities. Consequently, it will inform general practitioners about CKD screening and offer them financial incentives for meeting annual screening targets among their at-risk patients.”(33,34)

Integrating CKD screening into routine health checks is one solution that can make a significant difference.

Encouragingly, recent developments at the EU level suggest policymakers are catching on to the benefits of early detection. The Council’s conclusions on improving cardiovascular health in the EU, published in December under the Hungarian Presidency, acknowledge CKD’s strong link to cardiovascular disease. It also urges member countries to introduce joint health checks for cardiovascular disease and diabetes that include kidney function assessment.(35)

The path forward

International guidelines for CKD detection are well-researched and ready for implementation. Policymakers have the tools and knowledge to act — now they need to prioritize early detection and equitable access to care.

Integrating CKD screening into routine health checks is one solution that can make a significant difference, particularly for at-risk patients such as those with diabetes, hypertension and cardiovascular conditions. Simple, scalable tests such as blood and urine analysis make early CKD detection accessible, enabling interventions when the disease is easier and less costly to manage.(3)

“Nobody should face the need to receive dialysis or transplantation in the last part of the 21st century. If all European countries would include CKD as part of joint health checks at the primary care level it would have massive positive impacts on health care systems and give hope for patients. We urge all countries to follow suit,” says Daniel Gallego, president of the European Kidney Patients´ Federation.

Given CKD’s strong ties to other major conditions such as diabetes, heart disease and hypertension, incorporating CKD into existing NCD policies is essential for a robust and effective approach to managing Europe’s growing health challenges.(8) For too long, CKD has been an afterthought — it’s time for policymakers to correct this life-threatening oversight.

To achieve this, key actions for policymakers include:

Integrate CKD screening into routine health checks, using simple, cost-effective tools such as blood and urine tests.

Embed CKD into national NCD strategies and frameworks, ensuring kidney health is part of a comprehensive public health response.

Ensure diagnosed patients receive guideline-directed treatment, following international standards such as the KDIGO guidelines, to help slow disease progression.

Prioritize equitable access to CKD care, ensuring early intervention for at-risk populations, particularly those with comorbid conditions.

Finally, these efforts must extend beyond Europe. The WHO should formally recognize CKD as a priority NCD and include it in global health frameworks, such as the WHO Global Monitoring Framework for NCD Prevention and WHO NCD “best buys.” This would provide policymakers worldwide with a roadmap to reduce the burden of CKD and drive coordinated international action.

Now is the time

Europe stands at a critical juncture. With the tools, guidelines and policy frameworks already within reach, there is a clear opportunity to address CKD through early detection, integrated health checks and access to treatment. However, failing to act now will likely escalate costs, strain health care systems, increase the environmental impact and worsen patient outcomes across Europe and beyond.

The steps we take today will determine the future trajectory of this silent yet devastating disease. It’s time for Europe — and the world — to make CKD a priority and potentially spare millions from the burden of kidney failure.

Veeva ID: Z4-70462

Date of Prep: December 2024

References:

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