The 2025 U.S. National Security Strategy marks a major shift toward a narrowly defined "America First" agenda with significant implications for Europe and its health systems. It reframes global public goods, including disease surveillance, migration governance, and climate action, as burdens rather than shared responsibilities, while prioritising hard power, economic nationalism, strict border control, and fossil fuel expansion. Europe is urged to increase defence spending to 5% of GDP and reduce regulatory and welfare commitments, thereby creating fiscal pressures that risk crowding out investment in health and social care. Its rhetoric on migration, culture, and declining birth rates aligns with and empowers far-right movements, potentially accelerating welfare retrenchment and undermining access to care for migrant and marginalised populations. This Viewpoint analyses the implications of the 2025 U.S. National Security Strategy for public health and health systems in Europe, with particular attention to welfare, migration, climate, and multilateral cooperation. A weakened WHO, reduced U.S. multilateral engagement, and more transactional transatlantic relations threaten global health security. Europe must safeguard health systems, equity, and the multilateral global order. The health implications are clear. If implemented, the NSS could reshape global political and economic systems that underpin population health, ranging from disease surveillance and migration to trade, energy, and economic governance. The NSS frames these domains primarily as national security imperatives for the United States to determine rather than as shared responsibilities to be collectively agreed upon. This has profound implications for Europe, where health systems are deeply embedded in welfare states, regulatory regimes, and supranational institutions that the NSS portrays as obstacles to U.S. power. The NSS's framing is consistent with the America First Global Health Strategy, which subordinates global health engagement to domestic strategic returns. Together, these documents normalise conditionality in partnerships, prioritise bilateral over multilateral modalities, and risk fragmenting global-health coordination, outcomes that would shift burdens onto European actors if left unaddressed." What is the U.S. expecting Europe to do? The NSS does not examine threats to Europe or articulate how the United States might help address them. Instead, it is preoccupied with what Europe should do to improve its standing in Washington's view. Second, the U.S. seeks to create economic conditions favourable to U.S. interests in Europe. This includes reducing regulatory barriers to trade, liberalising markets, and aligning industrial and trade policies more closely with U.S. priorities. While the NSS does not explicitly mention the regulation of health care markets, the document's logic suggests that policies perceived as constraining U.S. exporters, such as stringent pharmaceutical pricing policies or health technology assessment thresholds, may be targeted. In England, ministers seem to have accepted a rise in the reference cost-effectiveness threshold used by NICE from £25,000 to £35,000 per QALY as a concession to obtain tariff-free UK pharmaceutical exports to the U.S., 4 agreed to even though evidence already shows that drugs approved at the previous threshold crowd out spending on health services that could have provided better value for money. 5 Above all, the NSS appears designed to resonate with and empower right-wing and populist political movements in Europe. The NSS condemns it thus: the “ European Union and other transnational bodies that undermine political liberty and sovereignty, migration policies that are transforming the continent and creating strife, censorship of free speech and suppression of political opposition, cratering birthrates, and loss of national identities and self-confidence ” p25. The reference to ‘free speech’ also signals pushback against EU efforts to regulate large U.S. technology and social-media platforms, on taxation, competition, data, and online harms. A Europe composed of more inward-looking, nationally oriented states is easier to engage transactionally, whether on defence, trade, or energy. Eligibility rules, documentation hurdles, and targeted exclusions have reduced access to primary care, public insurance, and social assistance for migrants and mixed-status families, with spillovers to public health. If adopted in Europe, such approaches would likely widen coverage gaps, deter timely care-seeking, and heighten avoidable morbidity while deepening social division. A more transactional transatlantic relationship also increases the risk that health policy becomes subordinated to trade and industrial objectives, something already happening within the European Commission's Health Directorate General. 10 These environmental stresses will disproportionately affect vulnerable populations, strain health systems already under fiscal pressure, and undermine progress on climate-related health adaptation. In addition, Europe's ability to meet its own climate and health targets may be compromised if transatlantic trade and energy policies incentivise fossil-fuel dependence rather than a green transition. Finally, reduced commitment to international organisations undermines When warranted, the EU and willing states should leverage their market power, through procurement, standard setting, and access to investment, to secure guardrails around health, data, and environmental protections in transatlantic engagements. The challenge for Europe, therefore, is not only to navigate a shifting security environment but to prevent that shift from eroding the social, institutional, and political foundations of health. This requires distinguishing among cases in which alignment with U.S. objectives is strategically necessary, optional, or unacceptable due to the health consequences.

Modern integration processes are taking place in the context of a profound transformation of the global economy, where globalization and regionalization complement each other. Since the potential for reducing tariff barriers has been exhausted, it is important to eliminate non-tariff restrictions and harmonize domestic economic policies. An important aspect is the change in the formats of international economic interaction, which is caused by difficulties in implementing free trade rules and increased protectionist measures. The purpose of the study is to analyze economic integration and cooperation in the context of globalization, in particular, to study the key challenges and prospects for the development of integration processes. It is proved that modern international economic integration is characterized by the growing role of non-tariff measures, the expansion of trade blocs and the emergence of new mixed formats of cooperation. The impact of regionalization contributes to the growth of international trade and economic convergence, as the reduction of non-tariff barriers and the formation of open trade blocs contribute to economic growth and reduce the likelihood of armed conflict. At the same time, international integration faces threats, including disintegration trends in the world’s major economies, which could lead to large-scale trade conflicts and weaken the functions of multilateral regulatory mechanisms. The importance of the WTO in ensuring trade and economic liberalization and resolving disputes between countries remains key to the stability of international trade, despite the existing challenges. An important aspect is Ukraine’s prospects in the context of integration into the European market, where it is necessary to reform the judicial system, fight corruption, reduce administrative pressure on business, improve the VAT refund mechanism and create incentives for self-employment in order to successfully adapt to European standards. Modern integration processes are characterized by the emergence of new mixed formats of economic interaction that complement traditional models of regional and global integration. However, integration faces challenges, including the fragmentation of the global economic space, growing protectionism, and uneven economic development. European integration offers significant opportunities for Ukraine, but its effectiveness depends on domestic reforms and adaptation to international standards. Further development of integration processes will require a balance between market openness and protection of national economic interests.

trade restrictive measures since then. In its report, the World Bank says most of the world's major economies are resorting to protectionist measures Protectionism, sometimes referred to as trade protectionism, is the economic policy of restricting imports from other countries through methods such as tariffs on imported goods, import quotas, and a variety of other government regulations. Proponents argue that protectionist policies shield the producers, businesses, and workers of the import-competing sector in the country from foreign competito Certain policies of First World governments have been criticized as protectionist, such as the Common Agricultural Policy in the European Union, longstanding agricultural subsidies and proposed "Buy American" provisions in economic recovery packages in the United States. Heads of the G20 meeting in London on 2 April 2009 pledged "We will not repeat the historic mistakes of protectionism of previous eras". Adherence to this pledge is monitored by the Global Trade Alert, providing up-to-date… Opponents argue that protectionist policies reduce trade, and adversely affect consumers in general (by raising the cost of imported goods) as well as the producers and workers in export sectors, both in the country implementing protectionist policies and in the countries against which the protections are implemented. Protectionism has been advocated mainly by parties that hold economic nationalist positions, while economically liberal political parties generally support free trade. Although trade liberalization can sometimes result in unequally distributed losses and gains, and can, in the short run, cause economic dislocation of workers in import-competing sectors, free trade lowers the costs of goods and services for both producers and consumers. == Protectionist policies == A variety of policies have been used to achieve protectionist goals. These include: Tariffs and import quotas are the most common types of protectionist policies. A tariff is an excise tax levied on imported goods. Originally imposed to raise government revenue, modern tariffs are now used primarily to protect domestic producers and wage rates from lower-priced importers. However, protectionism can be used to raise government revenue and enable access to intellectual property, including essential medicines. Protectionism is frequently criticized by economists as harming the people it is intended to help. Mainstream economists instead support free trade and argue that protectionism reduces the overall economic efficiency, stifles innovation and raise prices for consumers. Without foreign competition, domestic industries are insulated from market forces, which can reduce their incentive to innovate, improve efficiency or maintain high-quality standards. While these stockpiles are depleted, future imports of cooling products into the European Union will be costlier and more difficult to obtain by private individuals and small companies. ==== Growth ==== An empirical study by Furceri et al. (2019) concluded that protectionist measures like tariff increases have a significant adverse impact on domestic output and productivity. A prominent 1999 study by Jeffrey A. Frankel and David H. Romer found while controlling for relevant factors, that free trade does have a positive impact on growth and incomes. The effect is quantitatively large and statistically significant. Economist Arvind Panagariya criticizes the view that protectionism is good for growth. Such arguments, according to him, arise from "revisionist interpretation" of East Asian "tigers"' economic history. The Asian tigers achieved a rapid increase in per capita income without any "redistributive social programs", through free trade, which advanced Western economies took a century to achieve. Protectionists have often pointed to German and American industrialization during this period as evidence in favor of their position, but economic growth is influenced by many factors other than trade policy, and it is important to control for these when assessing the links between tariffs and growth." ==== Developing world ==== There is broad consensus among economists that free trade helps workers in developing countries, even though they are not subject to the stringent health and labor standards of developed countries. This is because "the growth of manufacturing—and of the myriad other jobs that the new export sector creates—has a ripple effect throughout the economy" that creates competition among producers, lifting wages and living conditions. The Nobel laureates Milton Friedman and Paul Krugman have argued for free trade as a model for economic development. Alan Greenspan, former chair of the American Federal Reserve, has criticized protectionist proposals as leading "to an atrophy of our competitive ability. ... By the 1840s, the United Kingdom had adopted a free-trade policy, meaning open markets and no tariffs throughout the empire. The Corn Laws were tariffs and other trade restrictions on imported food and corn enforced in the United Kingdom between 1815 and 1846, and enhanced the profits and political power associated with land ownership. The laws raised food prices and the costs of living for the British public, and hampered the growth of other British economic sectors, such as manufacturing, by reducing the disposable income of the British public. In its report, the World Bank says most of the world's major economies are resorting to protectionist measures as the global economic slowdown begins to bite. Economists who have examined the impact of new trade-restrictive measures using detailed bilaterally monthly trade statistics estimated that new measures taken through late 2009 were distorting global merchandise trade by 0.25% to 0.5% (about $50 billion a year). Since then, however, President Donald Trump announced in January 2017 the U.S.

applications to developing countries. The use of trade barriers has shifted throughout history. Protectionist policies were commonplace in the mercantilist Trade barriers are government-induced restrictions on international trade. Most trade barriers work on the same principle: the imposition of some sort of cost (money, time, bureaucracy, quota) on trade that alters the price or availability of the traded products. Barriers take the form of tariffs (which impose a financial burden on imports) and non-tariff barriers to trade (which uses other overt The merits of trade barriers are often disputed. Proponents of free trade point to the overall economic gains that result from trade via the theory of comparative advantage, while protectionists argue that trade barriers are necessary to sustain “weak” industries and create a self-sufficient economy. High-income countries tend to have fewer trade barriers than middle income countries which, in turn, tend to have fewer trade barriers than low income countries. The most common goods subject to trade barriers are on agricultural goods, textiles, and apparel. Trade barriers can be split into two categories, tariff and non-tariff. Tariffs are taxes levied on imports, and can serve as a revenue source for a country, a protection for domestic industries, or a retaliatory measure against another state. Non-tariff barriers take a variety of forms, including import and export licenses, quotas, subsidies, and embargoes. National firms often lobby their own governments to enact regulations that are designed to keep out foreign firms, though modern trade deals are one way to reduce these barriers to trade. Georgetown University Professor Marc L. Busch and McGill University Professor Krzysztof J. Pelc note that modern trade deals are long and complex because they usually tackle these non-tariff barriers to trade, and these barriers are often more complicated to negotiate than tariffs. Intellectual property (IP) regulations, for exa The merits of trade barriers are often disputed. Proponents of free trade point to the overall economic gains that result from trade via the theory of comparative advantage, while protectionists argue that trade barriers are necessary to sustain “weak” industries and create a self-sufficient economy. High-income countries tend to have fewer trade barriers than middle income countries which, in turn, tend to have fewer trade barriers than low income countries. The most common goods subject to trade barriers are on agricultural goods, textiles, and apparel. Trade barriers can be split into two categories, tariff and non-tariff. Tariffs are taxes levied on imports, and can serve as a revenue source for a country, a protection for domestic industries, or a retaliatory measure against another state. Non-tariff barriers take a variety of forms, including import and export licenses, quotas, subsidies, and embargoes. National firms often lobby their own governments to enact regulations that are designed to keep out foreign firms, though modern trade deals are one way to reduce these barriers to trade. Georgetown University Professor Marc L. Busch and McGill University Professor Krzysztof J. Pelc note that modern trade deals are long and complex because they usually tackle these non-tariff barriers to trade, and these barriers are often more complicated to negotiate than tariffs. Intellectual property (IP) regulations, for example, is a non-tariff barrier to trade that is difficult to regulate: developing countries see IP protections as inadequate while developing countries see the protections themselves as a barrier, creating a conflict that makes negotiation very difficult. If the interwar period is defined by protectionism and the increase of trade barriers, then the era post-World War II is marked by an increased commitment to liberalism, free trade, and the evolution of an international rules-based order. The RTAA not only laid the foundations for global trade liberalization, but it also put the United States as a leader of that push. Unlike the pre-1914 era of liberalization, this new era of lowered trade barriers was created in tandem with international organizations meant to support the development of freer trade. The 1944 Bretton Woods Conference and the subsequent creation of the International Monetary Fund and the World Bank was the first step in the establishment of an international commitment to multilateralism. This did not mean progress towards free trade was linear, however. In 1948, the United States–who had been a lead advocate for international laws regulating trade–failed to ratify participation in the International Trade Organization (ITO), which would have regulated barriers to trade, including “tariff and nontariff barriers, restrictive business practices, economic reconstruction and development, and intergovernmental commodity agreements.” The trade barrier rules and tariff concessions that had been drafted before the establishment of the ITO remained in the form of the General Agreement on Tariffs and Trade (GATT). After the formation of the ITO failed, GATT was “transformed from a temporary agreement into a normative institutional framework in which governments pursued multilateral regulation and discussed trade policy.” Though countries were still able to pursue their own domestic economic interests, GATT regulated trade barriers–both tariff and non-tariff–by establishing norms and principles of nondiscrimination, reciprocity, and liberalization. The GATT, over a long series of negotiation rounds, significantly reduced tariffs on industrial goods and in 1979 also began to regulate non-tariff barriers such as subsidies, technical standards, and import licensing procedures during the Tokyo Round. These regulations–both on tariff and non-tariff barriers–were not without exemptions, however. Developing countries received special and differential treatment (SDT) through exemptions to the most-favored-nation

The COVID-19 pandemic exposed deep structural fragilities in globally integrated supply chains, triggering an unprecedented wave of disruptions in production, logistics, and cross-border trade. In its aftermath, governments and firms have pursued large-scale restructuring strategies-reshoring, nearshoring, friendshoring, and inventory buffering-while simultaneously adopting more protectionist trade measures, including tariffs, export controls, industrial subsidies, and strategic stockpiling. This paper critically examines the interplay between post-pandemic supply chain restructuring and the resurgence of protectionism in global trade policy. Drawing on recent empirical evidence, policy documents, and trade data from the WTO, IMF, OECD, and UNCTAD (2020-2024), the study analyses how disruptions in semiconductors, pharmaceuticals, energy, and food sectors have reshaped corporate sourcing strategies and national trade agendas. The findings indicate that while diversification and regionalisation enhance shortterm resilience, excessive protectionism risks fragmenting the global trading system, raising consumer prices, and slowing innovation. The paper argues for a balanced policy framework that integrates resilience, sustainability, and rules-based multilateral cooperation.