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Trade War With China To Hit US Healthcare

Without a carve-out for tariff exceptions for pharmaceuticals, prices will skyrocket for US patients, experts warn. As the United States and China engage in a trade war driven by steep tariffs imposed by President Donald Trump and counter levies by President Xi Xinping, one sector that could be deeply impacted – and in turn have a disproportionate impact on the health of Americans – is pharmaceuticals. The US imports 75 percent of its essential medicines. The Trump administration has begun its investigation into imports of medications and the active ingredients needed to make them, saying a lack of that in the US poses a national security threat. It as also threatened sectoral tariffs – that could range from 7.5 percent to 100 percent – in addition to the 145 percent currently in place on China. While pharmaceuticals have been exempt from Trump’s reciprocal tariffs thus far, it’s not clear how long that will last, especially with potential sectoral levies in the pipeline. In the immediate term, there is some insulation between the looming escalated prices and what consumers will pay when they go to pick up their medication at their local pharmacy. Unlike other goods, pharmaceutical prices for consumers are not subject to the same instantaneous market fluctuations. The complex supply chain across the pharmaceutical industry means that there is a lag between tariffs and the impact they might have on patients. At the same time, there are stockpiles at nearly every step of the supply chain. Wholesalers have their own, as do pharmaceutical giants and even the federal government. “A lot of these medications, especially ones that are, like, in pill forms, are pretty stable for a long time,” Bruce Y Lee, professor of health policy at the CUNY Graduate School of Public Health and Health Policy, told Al Jazeera. In the short term, pharmaceutical companies and healthcare providers can eat the spike in costs like they did during the COVID-19 pandemic. That gives pharmaceutical companies and trade groups time to plead with the administration to ensure exceptions from the tariffs continue. India supplies about half of all generic drugs used in the US. However, it depends on China for 80 percent of its active pharmaceutical ingredients (APIs), the chemical compounds medications are made from. One of the globe’s biggest pharmaceutical giants said it worries any tariff would drive up prices and hurt patient care. In a shareholder meeting, Michel Demare, chairman of the board for AstraZeneca, said, “We still strongly believe that medicines should be exempted from any kind of tariffs because, at the end, it is just harming patients’ health systems and restricting health equity.” AstraZeneca did not respond to Al Jazeera’s request for further remarks. Eli Lilly and Johnson and Johnson echoed similar concerns. In the last six months, all three companies have pledged multibillion-dollar investments to ramp up manufacturing as well as research and development in the US. But pharma giants will be able to bite the cost only for so long. Falling stock prices for pharma giants mean that they will need to find other ways to raise the stock price to meet their fiduciary responsibilities to shareholders. Experts say they can do that by renegotiating drug prices higher, depending on the medication. That causes a downstream effect that will lead to higher insurance premiums across the board and higher prices for Americans who rely on these drugs daily. “Demand for many pharmaceuticals is not flexible. This is not a consumer good,” Lee pointed out. “When you impose something that increases the cost, like the tariff, you can’t really change the demand … and will ultimately hurt patients”. According to a report from the supply chain analytics company Exiger released last week, the US relies on China for as much as 80 percent of active pharmaceutical ingredients. For generic antibiotics, in particular, the dependence is much higher at 90 percent. Because China disproportionately produces more generic drugs, which are 80 to 85 percent cheaper than their brand-name alternatives, tariffs on China will hurt low-income communities the hardest. “If there’s a place where you save money, it is generic, and that’s exactly where the increases will be. Generic companies work on the slimmest margins, and they’re just not in a position to absorb [that],” Michael Abrams, partner at Numerof and Associates, a global healthcare consulting firm, told Al Jazeera. Recent analysis from the financial services company ING found that even a 25 percent pharma tariff could force cancer patients to pay as much as $2,000 more for a 24-week supply. Tariffs could force makers of generics to pull out of the US market altogether, says Tom Kraus, vice president of government relations for the American Society of Health-System Pharmacists (ASHP) told Al Jazeera. “Imposing tariffs on medications and their ingredients could force generic drug manufacturers with already slim profit margins to drop out of the US market for a given medication, resulting in drug shortages for American patients,” Kraus said. About 90 percent of the medications prescribed in US pharmacies are generic or biosimilar (meaning ingredients that have similar effects), according to a report from the Association of Accessible Medicines published in February. “It will cause a lot of reverberations throughout because someone’s going to have to pick up the tab. This will result in a smaller percentage of medication costs being covered by insurance companies, and thus this burden pushed to patients and consumers,” Lee added. Americans are already struggling to meet the costs of healthcare as it is. One in three Americans say they cannot take medications they are prescribed because of the cost, and 11 percent of Americans say they cannot meet their healthcare costs, with a higher burden on Hispanic adults at 18 percent overall. The Congressional Budget Office estimates that 7.7 percent of Americans are uninsured, meaning their medical costs are out of pocket. Even for those who do have insurance, public health experts believe that insurance premiums will increase if Trump moves ahead with pharmaceutical tariffs. “They’re going to spread that out among anyone paying insurance as a whole. That’s the whole concept of insurance,” Lee said. More expensive drugs are produced stateside or in Europe. Those could also get pricier. There is currently a 10 percent tariff in place impacting these drugs but that could go higher when country-specific tariffs, currently on pause, kick in. Drugs that come out of Europe are more often the blockbuster brand-name medications. Zepbound, Eli Lilly’s weight loss medication, for instance, is made in Ireland. If tariffs kick in there, out-of-pocket costs for US patients on Zepbound could run as much as $1,086.37 for a one-month supply, in contrast to as low as $25 with insurance. In February, the American Hospital Association (AHA), in a letter calling for tariff exceptions for pharmaceuticals, said it is worried that the levies would make existing supply chain strains worse. “Despite ongoing efforts to build the domestic supply chain, the US healthcare system relies significantly on international sources for many drugs and devices needed to both care for patients and protect our healthcare workers. Tariffs, as well as any reaction of the countries on whom such tariffs are imposed, could reduce the availability of these life-saving medications and supplies in the US,” the trade group said in a letter to the White House. “US providers import many cancer and cardiovascular medications, immunosuppressives, antibiotics and combination antibiotics from China. For many patients, even a temporary disruption in their access to these needed medications could put them at significant risk of harm, including death.” The AHA declined Al Jazeera’s request for additional comment. “Healthcare has a very elaborate logistics chain, and obviously, it varies from product to product, but some of them are very complicated,” Abrams of Numerof and Associates added. For instance, some APIs undergo two or three different processes and not all of them are in the same place before they even come to the US to be incorporated into the final product, he explained. “When you take all these relationships and throw them up in the air and see how they come down, inevitably it leads to disruption in supply,” he continued. There are more than 104 active drug shortages in the United States, including common antibiotics like amoxicillin. China is one of the world’s three biggest exporters of the drug, and the US is the largest importer. Another concern about the US’s extreme reliance on China is that the country’s API market is only expected to grow by 7.8 percent over the next five years, according to the market research firm Modor Intelligence. During the COVID-19 pandemic, when trade essentially halted temporarily, there were concerns that the US did not have enough medications in its strategic reserve to handle a temporary halt. Both Republicans, such as Arkansas Senator Tom Cotton and Democrats, such as former President Joe Biden have long called for less reliance on China for pharmaceuticals as a result. “When you have supply chains that are not well diversified or dependent on just particular channels, then that supply chain is fragile and there’s risk,” Lee said. There have long been suggestions from prominent Chinese voices, including economist Li Daokui, that have called on leadership in Beijing to reduce antibiotic exports to the US as a tool in a trade war. But experts agree that Trump’s rapid approach does not give companies time to prepare and thus is putting patients at risk. The ASHP told the White House in a February letter that tariffs “should be applied selectively and dovetail with other incentives to increase domestic production and promote a stable supply chain”. “You can’t do it in the 18 months that you’re trying to get it done, OK? And it’s not even exactly a four-year undertaking either,” Abrams added. Some companies have said they will bring more pharmaceutical manufacturing jobs stateside. Swiss pharmaceutical giant Roche announced a $50bn investment in the US over the next five years, which will include funds to build research and development facilities and expand existing manufacturing operations. Roche follows Novartis, which announced that it would invest $23bn over the next five years to expand its US infrastructure. That includes thousands of new jobs in seven facilities that will manufacture drugs and APIs. But building and getting plants like these in production will not solve the immediate issue, according to ASHP. “It is important to note that building new pharmaceutical manufacturing capacity will take several years. In the meantime, tariffs risk higher prices for those drugs that can pass increased costs to consumers, and shortages for generic drugs that can’t,” Kraus of ASHP continued. The White House did not respond to Al Jazeera’s request for comment. Follow Al Jazeera English:...

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VIDEO: Sanwo-Olu Shows Off DJ Skills At Lagos Carnival

Lagos State Governor, Babajide Sanwo-Olu, left many Lagos youths shocked when he mounted the DJ booth to thrill guests at the Lagos Fanti Carnival on Monday. A viral video on social media showed the DJ Sanwo-Olu ‘scratching’ to Asake’s ‘Fuji Vibe’ and hyping the crowd, earning loud cheers and admiration from young Lagosians. In the short clip, Governor Sanwo-Olu—dressed casually—was fully immersed in the moment as he showcased his DJ skills alongside popular Disk Jockey, DJ Spinall, with the crowd vibing to his selection. Click here to watch the video

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What Is The Resistance Front, The Group Claiming The Deadly Kashmir Attack?

Founded in 2019, the little-known group has now taken centre stage in the conflict between India and the rebels. New Delhi, India — Even as news of the deadliest attack on Indian-administered Kashmir’s tourists in decades filtered in on social media platforms and television screens, a message appeared on Telegram chats. The Resistance Front (TRF), a little-known armed group that emerged in the region in 2019, claimed responsibility for the attack in which at least 26 tourists were killed and more than a dozen others were injured on Tuesday. Armed rebels, who have been fighting for Kashmir’s secession from India, had largely spared tourists from their attacks in recent years. Tuesday’s killings changed that. But what is TRF, and what influence does it wield in Kashmir? And what is at stake for the Indian administration in Kashmir now? On a pleasant, sunny afternoon in the Baisaran meadow of Pahalgam town in Kashmir, tourists came under attack from gunmen who emerged from a nearby forest. The men armed with automatic rifles shot at least 26 tourists dead and injured several others. All those killed were men. India’s home minister, Amit Shah, reached Srinagar, the summer capital of the disputed region, as condolences poured in from world leaders, including United States President Donald Trump and Russian President Vladimir Putin. Indian Prime Minister Narendra Modi wrote on social media that “those behind this heinous act will be brought to justice … they will not be spared!” By then, TRF had claimed responsibility for the attack, even as the armed attackers who carried out the killings remained on the run. In a message that appeared on Telegram, TRF opposed the granting of residency permits to “outsiders”, who critics say could help India change the demography of the disputed region. “Consequently, violence will be directed toward those attempting to settle illegally,” it said. Though the targets of the attack were tourists — not newly arrived residents making Kashmir their home — the group’s choice of Telegram to claim responsibility did not surprise security officials. TRF is still, at times, referred to as “the virtual front” inside the security apparatus in Kashmir, for that is how it started. After the Indian government unilaterally revoked Kashmir’s partial autonomy in August 2019 and imposed a months-long clampdown, the group first took shape by starting messaging on social media. In reorganising Kashmir, the government also extended domicile status, which allows land owning rights and access to government-sponsored job quotas, to non-locals — the purported justification for the Pahalgam attack. The name The Resistance Front is a break from traditional rebel groups in Kashmir, most of which bear Islamic names. This, Indian intelligence agencies believe, was aimed at projecting “a neutral character, with ‘resistance’ in name focused on Kashmiri nationalism”, said a police officer, who has worked on cases involving armed groups for nearly a decade, requesting anonymity. However, Indian officials have consistently maintained that, in reality, TRF is an offshoot — or just a front — of the Lashkar-e-Taiba, a Pakistan-based armed group. India says Pakistan supports the armed rebellion in Kashmir, a charge denied by Islamabad. Pakistan says it provides only diplomatic and moral support to the Kashmiri people. It also condemned the attack on tourists in Pahalgam. Some Indian officials said they believe Tuesday’s attack may actually have been the handiwork of the Lashkar-e-Taiba, with TRF fronting responsibility to muddy India’s investigations into the killings. By 2020, the group started taking responsibility for minor attacks, including targeted killings of individuals. Its recruits consisted of fighters from an amalgam of splinter rebel groups. Since then, Indian security agencies have busted multiple groups of TRF fighters. But the group survived and grew. By 2022, a majority of the armed fighters killed in gunfights in Kashmir were affiliated with TRF, according to government records. TRF members were increasingly using small arms such as pistols to carry out targeted killings, including those of retired security personnel and people accused of being informers. The group also made headlines that year after it named Kashmiri journalists on a “traitor hit list” for allegedly colluding with the Indian state. At least five of the named journalists resigned immediately, as there is a history of such attacks. Shujaat Bukhari, a prominent Kashmiri journalist and editor of the Rising Kashmir publication, was assassinated on June 14, 2018, outside his office in Srinagar. The Kashmir police have attributed the killing to the Lashkar-e-Taiba. In June 2024, TRF also claimed responsibility for an attack on a bus carrying Hindu pilgrims, killing at least nine people and injuring 33, in Jammu’s Reasi area. The bus had plunged into a gorge during the attack. As TRF made its mark with its deadly attacks, it also used a mix of old and new strategies. Its English name stood out, as did its social media usage. But in other ways, it relied on more traditional techniques. Before TRF’s arrival, Kashmiri rebel commanders had, since 2014, increasingly adopted more public personas. Their groups would post videos on social media of their commanders casually walking through apple orchards, playing cricket, or riding a bike in Srinagar. This social media outreach led to a surge in recruitment. Among the commanders who adopted this method was Burhan Wani, whose killing in July 2016 led to an uprising, during which more than 100 civilians were killed in street protests. But after the 2019 crackdown, this approach no longer worked. TRF fighters, the newcomers on the scene, returned to tried and tested ways. “The faces were again hidden; the number of attacks fell, but the intensity became sharper,” said the police officer who requested anonymity. Under the leadership of Mohammad Abbas Sheikh, one of the oldest Kashmiri fighters — he is reported to have joined the rebellion in 1996 — the group focused its attacks on Srinagar. After his killing in 2021, and the killings of many other armed rebels in the subsequent year, TRF retreated with its fighters to jungles higher up in the mountains, a central intelligence official said on condition of anonymity. In January 2023, the Indian government declared TRF a “terrorist organisation”, citing the recruitment of rebels and smuggling of weapons from Pakistan into Kashmir. As more and more TRF fighters were killed by security agencies, their numbers dwindled. The rebels, according to the police and intelligence officials, were well trained but largely stayed in their high-altitude hideouts. Yet, if Indian security and intelligence agencies were caught off guard by the attack, some experts believe that is the outcome of holes in the Modi government’s Kashmir policy. Modi and Home Minister Shah, who is responsible for law and order and widely seen as Modi’s deputy, have repeatedly made claims of “normalcy” in Kashmir since the region’s semi-autonomous status was revoked in 2019. It was that assurance and the promotion of tourism by the Indian government that drove Kailash Sethi to Kashmir this summer with his family. Now, he is frantically looking to leave the region as soon as possible. “We were in Pahalgam just two days ago, at the same place where the attack happened,” Sethi, who is from Jamnagar in the western state of Gujarat, told Al Jazeera from Srinagar. “I cannot tell you how scared I am right now. I just want to take out my family.” On Wednesday, panic gripped tour and travel operators as visitors rushed to cancel their bookings and return home. Traffic jammed the roads to Srinagar airport, and prices to fly out of Kashmir increased by more than 300 percent. “There is no normalcy in Kashmir. And this ‘normalcy’ narrative is the most unfortunate thing about the Kashmir policy of this government,” said Ajai Sahni, executive director of South Asia Terrorism Portal, a platform that tracks and analyses armed attacks in South Asia. “First, zero militancy in Kashmir is an impossible objective to realise, at least in the absence of a political solution within the state,” said Sahni. “Secondly, the ‘normalcy narrative’ creates a situation where groups are encouraged to engineer attacks.” That, he said, is because they know that “even if a small attack occurs, it is not normal any more”. Apart from occasional attacks, rebel groups had largely spared the tourism industry so far, added Sahni. “This also led to a level of complacency, perhaps, in the security apparatus,” he said, adding that “this is a very abrupt escalation on the part of TRF”. By Tuesday evening, as the dead and injured were brought down on horseback and military vehicles, the police had sealed the resort town of Pahalgam. Several areas in Kashmir, including Srinagar, witnessed a shutdown after traders’ associations and political parties called for collective mourning. Raul, who works in the hospitality sector in Pahalgam and requested he be identified by his first name only, said he remains anxious for the future. “There will be crackdowns and the increased presence of armed forces in the area again,” he said. “Everyone, my clients, just wants to get out of Kashmir.” Follow Al Jazeera English:...

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Trump Accuses Ukraines Zelenskyy Of Harming Russia Negotiations

US president claims a peace deal is close, but accuses Ukrainian leader of making ‘inflammatory statements’. US President Donald Trump has lashed out at Volodymyr Zelenskyy, accusing the Ukrainian leader of making “very harmful” statements after he pushed back on ceding occupied Crimea to Russia in a potential peace deal. President Zelenskyy on Tuesday ruled out the idea of Ukraine ceding territory to Russia in any deal before talks on Wednesday in London among US, European and Ukrainian officials. “There is nothing to talk about – it is our land, the land of the Ukrainian people,” Zelenskyy said. His comments came after US media reports that the Trump administration was ready to accept recognition of annexed land in Crimea as Russian territory. In a post on the Truth Social platform on Wednesday, Trump accused Zelenskyy of stoking tension by “boasting” that Kyiv would not legally recognise ceding Crimea to Russia. “This statement is very harmful to the Peace Negotiations with Russia,” Trump said, adding that Russia invaded the Crimean Peninsula and annexed it back in 2014 “without a shot being fired”. “It’s inflammatory statements like Zelenskyy’s that makes it so difficult to settle this War,” Trump said. “He can have Peace or, he can fight for another three years before losing the whole Country.” Earlier, US Vice President JD Vance told reporters in India that the US has “issued a very explicit proposal to both the Russians and the Ukrainians”. “It’s time for them to either say ‘yes’, or for the United States to walk away from this process,” he added. Vance said land swaps would be fundamental to any deal. “That means the Ukrainians and the Russians are both going to have to give up some of the territory they currently own,” he added. In London, the US, Ukrainian and European officials held “substantive” truce talks despite US Secretary of State Marco Rubio cancelling his trip. Rubio’s no-show on Wednesday prompted a broader meeting with foreign ministers from Ukraine, the UK, France and Germany to be replaced by discussions at an official level, underscoring the tension between Washington, Kyiv and its European allies over Russia’s war in Ukraine. Zelenskyy said the talks had been marked by emotions and expressed hope that future joint work would lead to peace. “Emotions have run high today. But it is good that 5 countries met to bring peace closer,” he wrote on the X social media platform. “The American side shared its vision. Ukraine and other Europeans presented their inputs.” Trump’s Ukraine envoy Keith Kellogg said talks with Zelenskyy’s chief of staff Andriy Yermak were positive. “It’s time to move forward on President Trump’s UKR-RU war directive: stop the killing, achieve peace, and put America First,” he said in a statement on X. A spokesperson for British Prime Minister Keir Starmer played down any disappointment over Rubio’s abrupt cancellation, saying the talks involved “substantive technical meetings with European, US and Ukrainian officials on how to stop the fighting” triggered by Russia’s 2022 invasion. “We remain absolutely committed to securing a just and lasting peace in Ukraine, and these talks today are an important part of that,” the spokesperson said. A foreign office spokesperson said “all agreed to continue their close coordination and looked forward to further talks soon.” At the heart of Wednesday’s talks was an attempt to establish what Kyiv can possibly accept after Trump’s special envoy Steve Witkoff presented proposals that appeared to demand more concessions from Ukraine than Russia. Reuters reported that several sources said Witkoff’s proposals included recognising Russia’s 2014 annexation of Crimea, Washington beginning to lift sanctions on Russia and ruling out Ukrainian membership of NATO. Al Jazeera’s Zein Basravi, reporting from Kyiv, said Ukrainians found the US stance “simply unacceptable”. “Ukraine’s position is that it boggles the mind that … the US would ask an ally to give up sovereign territory of its own after an invasion,” he said. Mattia Nelles, who heads the German-Ukrainian Bureau think tank in Dusseldorf, told Al Jazeera that Europe now finds itself in the position of drawing red lines and trying to prevent Ukraine from being “thrown under the bus”. What was particularly worrisome to Europe was the US position on sanctions. “What the US is also throwing in the mix is sanctions relief, and this is very dangerous because it allows Russia to rearm very quickly while leaving Ukraine in a weaker position,” Nelles said, adding that this would remain unacceptable to both Kyiv and other European nations. Follow Al Jazeera English:...