As former U.S. President Donald Trump reignites debate over America’s high drug prices, attention is once again turning to how Europe manages to pay far less for the same medicines—even if pricing remains inconsistent across the continent.

Trump, speaking to journalists on Monday, criticized the European Union for what he called “brutal” and “nasty” tactics in negotiating with pharmaceutical companies. He announced a proposal to link U.S. drug prices to the lowest rates paid by other wealthy nations, declaring: “We’re going to pay what Europe pays.”

According to a RAND Corporation analysis, the U.S. spent $617.2 billion (€542.7 billion) on pharmaceuticals in 2022—nearly three times the €205.3 billion spent by 24 European countries combined.

While it’s true that Europeans generally pay less, the picture within the region is far from uniform. A report by the World Health Organization (WHO) found that drug prices vary widely across Europe, largely due to confidential negotiations with drugmakers, national budget constraints, and differing approaches to price regulation.

In Switzerland, per capita spending on medicines reached €525, whereas Croatia spent just €262. These discrepancies reflect not only national income levels but also the complex and opaque nature of price-setting in the region. “There’s essentially no transparency,” said Huseyin Naci, an associate professor of health policy at the London School of Economics.

Many European countries base their pricing on what other nations pay and use cost-effectiveness assessments to determine value. England and Sweden emphasize whether a drug justifies its cost, while Germany looks at how much additional benefit it offers over existing treatments.

Still, costs have risen across the continent. In Germany, for instance, hospital drug prices increased 11.5% from 2012 to 2022, while retail pharmacy prices rose 2.6% in the same period. Health insurers have warned that rising prices are putting pressure on public health budgets.

“If U.S. policy changes or drug companies push European nations to raise their prices, it would be highly disruptive,” Naci said.

European nations also differ in how drug costs are shared between public systems and individuals. In Cyprus, 90% of medicine expenses were covered by government or mandatory schemes in 2022. In Bulgaria, that figure was only 23%. Meanwhile, patients in some countries still pay out-of-pocket or through co-payments, depending on the condition being treated.

Despite lower overall spending, experts caution that European healthcare systems are already stretched thin. “There’s not much room left to absorb higher pharmaceutical costs,” Naci said.

A growing global shortage of nurses is being deepened by the increasing dependence of wealthier European nations on foreign-born healthcare professionals, according to a new report released by the World Health Organization (WHO) and partner organizations.

The report highlights a shortfall of 5.8 million nurses worldwide, with disproportionate reliance on international recruitment in Europe aggravating disparities between richer and poorer nations. While the global nursing workforce grew to 29.8 million in 2023—up from 27.9 million five years earlier—the gap in supply remains significant, particularly in low-income regions.

“We cannot ignore the inequalities that mark the global nursing landscape,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus.

Europe and Central Asia collectively host 7.2 million nurses, with projections suggesting the region will require one million more by 2030. Europe currently has 76.9 nurses per 10,000 people—five times the rate found in Africa and the Eastern Mediterranean. Yet this apparent abundance masks deeper structural issues.

Ageing Workforce and Limited Recruitment

One of the key challenges is an ageing workforce. In 2023, only 31% of nurses in Europe were under the age of 35, while 21% were aged 55 or older. In Eastern Europe, older nurses outnumber younger ones—a trend that raises concerns about long-term workforce sustainability.

The report found that in around 20 countries—most of them in Western Europe—the number of new nurses is not keeping pace with healthcare demand. This is largely driven by retirements and the increasing needs of ageing populations.

Dependence on International Nurses

In 23 European countries surveyed, 14% of the nursing workforce was foreign-born and another 10% had trained abroad. The WHO report criticized high-income nations for underinvesting in their own nursing education systems, leading to an overreliance on talent from lower-income countries. This trend, it warned, is worsening workforce shortages in regions already struggling to meet healthcare demands.

“There are striking inequalities in workforce distribution which have driven a surge in international recruitment and inequitable migration patterns,” said Howard Catton, CEO of the International Council of Nurses.

Training and Retention Challenges

Despite these concerns, Europe boasts a more developed training pipeline than most regions. In 2023, there were 42.7 new nurse graduates per 100,000 people in Europe, compared to a global average of 25.3. Much of this new talent comes from Central Asia, while Western Europe lags behind in nurse production.

European nurses also benefit from the highest starting salaries globally, with average entry-level pay at $2,508 (€2,205) per month. Additionally, 78% of European countries offer leadership development programmes for nurses—the highest rate globally.

The WHO report urges wealthier European countries to ramp up investment in domestic training programmes and implement stronger incentives to retain nurses, warning that continued reliance on international recruitment risks deepening global healthcare inequalities.