Public Health in the USA (Part 3): US policy changes and their implications for European healthcare

In this series on "Public Health in the USA" the author explores recent developments in public health and politics that created ripple effects in the present and future of science and medicine in the USA and beyond. We invite you to Parts 1 and 2 of this series:

From “therapeutic freedom” to eroding Evidence-Based Medicine

The recent reorientation of US health policy, particularly following the creation of the Make America Healthy Again (MAHA) Commission under Executive Order 14212, is raising significant concern within the international medical and scientific communities. While the initiative presents itself as a strategy to combat chronic disease and promote therapeutic freedom, it also reflects a broader ideological turn that deprioritises scientific consensus in favour of anecdotal evidence and non-validated interventions. As these developments gain traction in the United States, their effects are increasingly being felt beyond national borders, with potential implications for public health systems in Europe, including Germany.

One of the most notable consequences of the MAHA Commission’s work is the erosion of evidence-based medicine as the standard for clinical decision-making. The commission’s interim report, published in May 2025, advocates the integration of alternative therapies such as homeopathy, raw milk consumption, and herbal treatments into publicly funded care. These recommendations are largely based on personal testimonials rather than clinical trials, and cite sources that have been widely criticised for lack of methodological rigor. Although these ideas originate in a US specific political and cultural context, their influence is extending to patient attitudes in Europe.

In Germany, physicians have reported a growing number of patients requesting coverage for non-evidence-based treatments under statutory health insurance. Data from the GKV-Spitzenverband suggest that in 2025, approximately 5% of insured individuals submitted claims for alternative therapies, nearly double the rate observed in 2022. Similar pressures have been reported in France, where a 2024 CNAM report estimated that over 6% of public insurance claims involved complementary or non-validated treatments. In Italy and Spain, national health authorities have noted a gradual increase in public demand for such therapies, although formal reimbursement is largely restricted.

Although such treatments are not reimbursed by default, the persistence of these requests reflects a shift in patient expectations (one that increasingly mirrors the discourse propagated by US actors promoting “therapeutic freedom”). Moreover, the debate over the legitimacy of homeopathy has re-emerged in Germany, with some political figures calling for its reinstatement in public reimbursement schemes.

Vaccination confidence has also been affected

A 2024 study published in Scientific Reports observed significant disparities in COVID-19 vaccine uptake across German districts, with lower rates in areas characterised by lower educational attainment and socioeconomic status. At the EU level, Eurobarometer data from the same year indicate that vaccine confidence ranges widely (from 85% in Portugal to below 60% in Bulgaria) highlighting both the vulnerability of public trust and the potential for cross-border influence from US-driven narratives.

These findings suggest that trust in public health recommendations remains fragile, particularly in communities already vulnerable to misinformation. The situation is compounded by the widespread dissemination of vaccine-sceptical narratives via U.S.-based social media platforms, which continue to shape perceptions in Europe despite efforts by national institutions to counteract them.

Scientific collaboration under strain

Beyond its impact on clinical practice and patient behaviour, the shift in US health policy is also affecting scientific research and innovation. Structural changes within the National Institutes of Health (NIH) and the Food and Drug Administration (FDA) have created uncertainty for international collaborations. In early 2025, multiple US-based biotech companies publicly expressed concern over delays in FDA review processes, attributing them to staff cuts and administrative reorganisation.

According to reports from Reuters, these delays have prompted several firms to initiate early-phase clinical trials in Europe instead, citing faster timelines and more predictable regulatory engagement. The European Medicines Agency (EMA) confirmed a modest but measurable increase in multinational trial applications involving US sponsors choosing European coordination centres.

At the same time, NIH allocations for early-stage, investigator-initiated research projects fell by an estimated 1.8 billion dollars in the first half of 2025. This reduction has disrupted dozens of projects that included European partners, particularly in vaccine development and pain pharmacology. The result is a partial decoupling of transatlantic research efforts, with European institutions needing to reassess their dependencies and risk exposure.

In response, the European Commission launched the “Choose Europe” initiative, allocating € 500 million to attract international researchers and strengthen EU-based consortia. While this initiative aims to stabilise the scientific landscape, it also signals a growing recognition that US leadership in medical research can no longer be taken for granted.

Redefining expertise and reshaping the doctor–patient relationship

The repercussions of these shifts extend to the symbolic role of physicians and medical experts. By devaluing established expertise and portraying scientific consensus as a form of institutional bias, the MAHA Commission contributes to a broader narrative in which doctors are no longer seen as neutral guides, but as representatives of contested systems. This narrative is not limited to the United States. In Germany, anecdotal reports from clinical settings indicate a rise in patients questioning standard diagnostic pathways or rejecting treatment plans in favour of online information or influencer recommendations.

This change in the doctor–patient relationship increases the cognitive and emotional burden on clinicians, who must not only justify each clinical decision with exhaustive explanation, but often counteract misinformation directly. Young physicians in particular report difficulties navigating these conversations, especially when faced with strong ideological positions. Professional associations have begun addressing this issue through continuing education modules focused on communication in the context of contested science.

Public confidence in expert knowledge is a cornerstone of effective medical care. If the authority of clinicians is systematically undermined, the ability to deliver consistent, high-quality healthcare will be compromised, regardless of the scientific validity of the treatments offered.

Regulatory pressures and European responses

The political and regulatory consequences of US policy developments are beginning to surface in Europe. While American laws have no legal effect within the EU, they exert normative influence. References to “therapeutic freedom,” as articulated in MAHA documents, have started appearing in discussions among European advocacy groups. In Germany, parliamentary committees have received informal proposals to consider broader integration of complementary medicine in publicly funded care, using the US model as a point of comparison.

In parallel, there are economic and trade-related effects. The European Federation of Pharmaceutical Industries and Associations (EFPIA) warned in April 2025 that US tariff threats on pharmaceutical imports could disrupt collaborative research, particularly in biologics and vaccine manufacturing. Although no measures have been implemented at the time of writing, the threat of regulatory divergence and commercial barriers has added pressure to existing scientific and institutional tensions.

Perhaps the most concerning aspect is the risk of regulatory fragmentation within Europe itself. As individual member states respond differently to pressure from complementary medicine advocates, the coherence of EU-wide standards may weaken. Germany currently maintains a relatively strict framework based on recommendations from the Standing Committee on Vaccination (STIKO) and federal health authorities. However, variations in cross-border care, telemedicine services, and patient mobility may challenge the ability to maintain consistent application of evidence-based criteria.

In this context, defending evidence-based medicine is not merely a professional or academic concern: it’s a public health imperative. The European Union must reaffirm the principles of transparency, methodological rigor, and clinical relevance as the foundation of healthcare policy and practice. This includes resisting pressures to accommodate non-validated therapies, strengthening communication strategies to counter misinformation, and ensuring that funding mechanisms prioritise scientific merit over ideological trends. If US leadership continues to retreat from international cooperation and evidence-based standards, European institutions must be prepared to assume a more prominent role, not only to protect their own populations, but to preserve the global framework that supports high-quality, science-informed medicine.

Rennert P, Scholz S, Brandt M. Socioeconomic and educational disparities in COVID-19 vaccine uptake in Germany. Sci Rep. 2024;14:12873. doi:10.1038/s41598-024-75273-9
Robert Koch Institut. STIKO vaccination recommendations. 2024.
The White House. Make our children healthy again: Assessment. 2025 May 22.
GKV-Spitzenverband. Bericht zur Inanspruchnahme von Komplementärmedizin im GKV-System. 2025. [Internal report]
Haute Autorité de Santé. Évaluation de l’homéopathie – Avis final. 2019.
Caisse Nationale d’Assurance Maladie. Rapport sur les dépenses de santé alternatives en France. 2024.
European Commission. Eurobarometer 538: Attitudes towards vaccination in the EU. 2024.
European Commission. Choose Europe: Research innovation package 2025–2027. 2025.
European Medicines Agency. Annual statistics on multinational clinical trial authorisations. 2025.
Reuters. Drugmakers warn EU that US tariffs further weaken sector in Europe: sources say. 2025 Apr 8.
Reuters. FDA upheaval pushes some biotech firms to plan early trials out of US. 2025 May 14.