Interview

Europe and Italy on the test: competing in the new geopolitics of health

Patrick Horber of Novartis analyses the global challenges the EU has to face in order to maintain its competitiveness and not fall behind the US and Asia. Is Brussels ready to change course?

by Francesca Cerati

15 April 2025

4' min read

Key points

The urgency of a new mindset in Europe
Clinical trials: EU delayed
Duty pressure
Barriers: cost containment and access times

4' min read

Health has become one of the main battlegrounds between the major powers and competition is becoming increasingly fierce. The United States and Asia are racing ahead while Europe risks falling behind. But today Brussels seems ready to change course, driven also by geopolitical risks and, in this scenario, Italy can play a key role as an industrial hub, provided it strengthens its production capacity and attracts investment in the most advanced technologies. This is the vision of Patrick Horber, International president of Novartis.

The urgency of a new mindset in Europe

"If we compare Asia and Europe, a profound difference in their approach to innovation is evident, and developments in recent months are leading Europe to realise the need to take action to support its competitiveness, because the risk of losing ground to the United States but also with respect to China and Japan, is increasingly tangible,' Horber told Il Sole24Ore. 'To address this risk, Europe must change its mindset towards innovation, shifting from a vision of cost to a perspective of investment and enhancement of a sector that is an important driver of economic development.

Looking at the life science sector and the ongoing reform of pharmaceutical legislation, it is clear to the Novartis manager that Europe is no longer supporting innovation as it used to. "I am thinking for example of the issue of intellectual property, on which discussions are ongoing in Europe to reduce the protection of regulatory data from 8 years to 6 years, which would amount to a 25% reduction. This is a very significant element, because in countries like Japan and China patent protection is increasing, showing that in these countries the pharmaceutical industry is seen as an engine for growth in the economy and not as a cost'.

In addition to the declining number of patents registered annually in Europe, the other issue is the regulatory approval of new molecules: 'out of five molecules launched in the US, one has not even been submitted for regulatory approval in Europe. This means that 20% of the molecules do not enter the European market, and we are talking about innovative molecules for chronic diseases and oncology,' Horber continues.

Clinical trials: EU lagging behind

Another very important area that represents a challenge for the competitiveness of the sector in Europe is clinical trials, which have increased in countries such as China, where the government is offering data and intellectual property protection to foster innovation. 'While clinical trials in China are now growing at a rate of 15 per cent every year, in the US the growth is 10 per cent and in Europe it is about 5 per cent,' Horber points out. 'In fact, the number of European patients involved in clinical trials is lower than it was 10 years ago, a situation that deserves great attention.

What weighed, according to Horber, was a complex and fragmented regulatory system, which made investment less attractive compared to the American and Asian models. But something is changing. Over the past three weeks, the European Union has shown interest in the pharmaceuticals industry and has engaged it to discuss the potential consequences of tariffs and how to intervene to support the sector.

Duty pressure

"At the moment, President Trump has not imposed tariffs on pharmaceuticals, and I believe that in the face of patient needs, there should be no obstacles to the supply of ingredients or distribution of drugs," Horber comments. "As a company, we have manufacturing sites around the world and our supply chain is structured to cope with natural disasters or other impediments, which could jeopardise the production and supply of our drugs to patients who need them. This helps us mitigate risks, including those of possible tariffs, which could still impact our business, but we feel prepared to handle these challenges." That said, the Swiss pharmaceutical group in the face of Donald Trump's pre-announced duties has announced its intention to expand its manufacturing and R&D presence in the US, with a total investment of $23 billion over the next five years. In particular, the company will also build two new manufacturing plants for radioligand therapy (Rlt) in Florida and Texas and expand three Rlt manufacturing facilities in Indianapolis, Indiana, Millburn, New Jersey, and Carlsbad, California. As a reminder, Novartis has three important production sites in Italy, which are ranked first in terms of their contribution to export growth.

Barriers: cost containment and access times

'As a company we continue to invest in Europe and particularly in Italy, where Novartis is the company with the largest number of active clinical trials,' Horber points out. And as far as Italy is concerned, one of the main exporters of drugs, Horber emphasises the excellence of our country, but also the limits of health expenditure containment policies, which risk slowing down access to innovation.

"Italy plays a key role for Novartis and the European life science industry: it is among the countries with the most patents in the sector and drives pharmaceutical exports. Our three main production sites in Italy are leaders in the export of innovative therapies, such as radioligands and cardiovascular drugs,' observes Horber, who adds: 'Italy recognises the value of innovation, but at the same time adopts restrictive mechanisms such as hospital spending caps and payback, which risk penalising patients' access to new treatments. The country spends about 6.2 per cent of GDP on healthcare, against a European average of 6.8 per cent and even higher values in Germany. Moreover, the approval and reimbursement process for drugs is slow compared to the main European countries'.

In short, in the new geopolitics of health, there is also a redefinition of supply chains that should not be underestimated.