As Europe plans its response to the neurological disease burden, a fundamental measurement gap is being overlooked — and the cost of ignoring it is being felt.

A briefing requested earlier this year by the European Parliament’s Committee on Public Health (SANT) put it plainly: neurological diseases are one of Europe’s most urgent and rapidly expanding health, social and economic challenges. Published in February 2026, it calls for a coordinated European plan linking prevention, early diagnosis, research and innovation.¹ But before Europe considers what that plan should look like, a foundational question demands attention: are we measuring the right things?

Multiple sclerosis (MS), a chronic, progressive disease of the central nervous system that disrupts communication between the brain and the body, offers a revealing case study. Consider a woman in her mid-30s, working, raising a family, managing what her neurologist calls “stable” MS. She has not slept properly in years, her memory has been slipping and she is cutting her hours at work. Her last clinical note reads: “No change.” On paper, she is stable, but in reality she is anything but.

Her story is not unusual. According to research commissioned by Sanofi^*, the gap between what health systems measure and what people with MS experience may be costing individuals, families and economies more than we realize.³

The stakes for Europe

Over 3 million people globally live with MS and Europe has the highest prevalence, at 133 per 100,000 people.^2,3 The condition strikes primarily during prime working years, meaning hundreds of thousands of people are navigating a progressive, unpredictable disease at precisely the point when inadequate support is felt most acutely.³

That support begins with measurement. And right now, the tools used to assess MS in clinical practice do not fully capture what people with the disease experience.³

The consequences extend far beyond the clinic: 82 percent of people with severe MS rely on unpaid family caregiving, yet this burden rarely appears in standard health data or policy design.³ When the full impact of disease is not measured, health systems can underestimate need, delay support, and overlook the wider effects on work, welfare and family life.³

The measurement gap

The Expanded Disability Status Scale (EDSS), the primary tool used to measure MS disability, was developed in 1983 to assess walking ability. We now know that MS affects far more than mobility. Fatigue affects 94 percent of people with MS, while 75 percent report cognitive difficulties, but both are absent in the EDSS assessment.³ In a field where clinical consensus is rare, seven in ten neurologists agree: a more comprehensive approach is needed.³

Growing recognition of smouldering neuroinflammation has made the need for new methods of quantifying MS progression increasingly urgent. This slow, chronic disease activity can persist even when a patient appears clinically stable, with effects that are subtle, cumulative and easy to miss until significant damage has already occurred.⁴

This is why Sanofi initiated the development of the Smouldering Associated Worsening (SAW) Index⁺. The SAW Index Study — led by an international steering committee of leading MS clinicians, researchers and patient advocates — is due to complete in 2027. Based on hundreds of hours of in-depth qualitative research with people with MS, the goal of the SAW Index is to provide neurologists with a comprehensive measurement framework that bridges the gap between lived experience and what clinical tools are currently able to detect.

According to the European Multiple Sclerosis Platform, people with MS experience an average of 14 symptoms within the first five years of diagnosis, with fatigue, sensory problems, sleep disturbances, cognitive impairment and balance problems among the most common.⁵ These are precisely the experiences the SAW Index is designed to surface, replacing static labels like “moderately affected” with measurement metrics grounded in the experience and words of people with MS.

The cost of this gap

These aspects of MS can be challenging to quantify and are associated with substantial societal and economic burdens. Lifetime productivity loss per person with MS ranges from €394,000 in France to €668,000 in Germany.³ The cost profile shifts significantly as the disease progresses: in mild MS, direct healthcare costs dominate; in severe MS, indirect costs become the primary driver.³ Indeed, lost wages, absenteeism, early retirement, disability payments and the growing burden on unpaid carers outweigh medical costs in many countries, placing growing long-term pressure on social insurance and disability systems.³

Early identification of progression could change that trajectory, extending years of employment, preserving household income, and reducing long-term dependence on disability and social benefits.^3,6 That is a cost-avoidance opportunity current measurement frameworks are missing.

Progress in motion

There is no single fix, but there is momentum.

MS care has advanced significantly in recent decades: diagnosis is happening earlier, treatment options have expanded and the focus is shifting from relapse control alone to slowing long-term disability progression.⁷ Furthermore, there is growing recognition of the importance of cognition, mental health, rehabilitation and the day-to-day realities that shape whether people living with MS can remain independent and active.⁸

The challenge now is to ensure policy keeps pace with that progress, and better measurement is part of the answer. If Europe wants health spending to deliver lasting value, it should see these improvements not as costs to be managed, but as investments in independence, participation, productivity and more sustainable health systems.

Time to act

The European Parliament’s SANT Committee has called for a fully funded European neurological health plan — one with the scale and ambition of Europe’s Beating Cancer Plan, aligning health, research and societal action in a unified framework.¹ MS offers a clear and immediate test case for what that ambition looks like in practice.

But ambitious plans require accurate data. If Europe is serious about a coordinated response to neurological disease, getting measurement right is not a secondary concern; it is the foundation on which everything else depends.

The people living with MS across the continent cannot wait for the tools that measure their disease to catch up with the science that understands it. Neither should policymakers.

^*Research commissioned by Sanofi. All editorial control retained by Economist Impact.
⁺Sanofi initiated and funds the SAW Index Study.

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References

1. European Parliament. Strengthening Brain Health: Policy Recommendations to Tackle the Rising Burden of Neurological Diseases. Available at: https://www.europarl.europa.eu/telastatic/cmsdata/302850/Briefing_Strengthening%20Brain%20Health_EN.pdf. Accessed: September 2026
2. MS International Federation. MS Atlas. Available at: https://atlasofms.org/map/global/epidemiology/number-of-people-with-ms. Accessed: September 2026
3. Economist Impact. Measuring what matters: Bridging the gap between disability impact and economic burden in multiple sclerosis. Available at: https://impact.economist.com/health-society/measuring-what-matters. Accessed: September 2026
4. Scalfari, A, et al. (2024) Smouldering-Associated Worsening in Multiple Sclerosis: An International Consensus Statement on Definition, Biology, Clinical Implications, and Future Directions. Ann Neurol 2024;00:1. DOI: 10.1002/ana.27034.
5. European Multiple Sclerosis Platform. (n.d.). Impact of multiple sclerosis symptoms (IMSS) [Fact sheet]. Accessed: October 2026
6. Cicely Dudley, Victoria Donnaloja and Karen Steadman. A guide for Health Care Professionals to have Conversations on Work with People with Multiple Sclerosis. Available at: https://emsp.org/wp-content/uploads/2017/02/Ready-for-Work-Employment-Guide.pdf. Accessed: September 2026
7. Montague T, Drummond J, Ng K, Parratt J. Advancements in multiple sclerosis. Intern Med J. 2025 Jun;55(6):895-904. DOI: 10.1111/imj.70023.
8. Giovannoni G, et al. MS care: integrating advanced therapies and holistic management. Front Neurol. 2024 Jan 30;14:1286122. doi: 10.3389/fneur.2023    

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Disclaimer

POLITICAL ADVERTISEMENT

• The sponsor is Sanofi.
• The political advertisement is linked to driving action in how neurological disease is measured in the EU (using MS as a case study) and driving action around the briefing requested by the SANT committee aimed at strengthening brain health (Policy Recommendations to Tackle the Rising Burden of Neurological Diseases).

More information here.

KYIV — Russia’s Vladimir Putin is preparing for a broader confrontation with Europe amid an uptick in the Kremlin’s hybrid attacks on the continent, Ukraine’s former Foreign Minister Dmytro Kuleba has warned.

In an interview with the Axel Springer Global Reporters Network, Kuleba, who was Ukraine’s foreign policy chief from 2020 to 2024, said that Russia’s continued war preparations and anti-European propaganda are signs that Putin is planning attacks on other European countries.

“Anti-European hysteria is being fueled in Russia, which I interpret as the preparation for a broader conflict with the rest of Europe,” said Kuleba, before adding: “We [Ukrainians] don’t have to drag you — Putin will drag you into the war.”

European officials say Moscow has upped its hybrid campaign across the continent in recent months, using cyberattacks, sabotage and disinformation to disrupt critical infrastructure and weaken support for Ukraine.

Kuleba said the failed drone attack on the Leipzig airport in Germany in August was a sign of “growing preparation” for an offensive on the continent. “They see how your intelligence operates. They see how your security forces operate. They see how you react and they draw conclusions,” he added.

In the aftermath of the incident, the German government concluded that Moscow was responsible for the attack, and ordered a review of security around sensitive locations.

However, Kuleba, who stood down as Ukraine’s foreign policy chief in September 2024, does not think Russia is preparing a full-scale offensive beyond Ukraine. In his view, Moscow is more likely to launch an attack on NATO countries involving drones targeting key infrastructure that would test the alliance’s unity and preparedness.

“The truth is that Russia does not need 400,000 more people to wage that war. It needs five drones,” he said, adding that in the event of an attack, “[Europeans] can call for NATO consultations… can call for restraint. But this will only encourage Putin to make the next step … He will always have enough drone and missile capabilities.”

Kuleba no longer believes Putin can be persuaded to end the war through negotiations. “He’s not looking for a solution, for a pause, and there will be no moment when he will start looking for it,” he said, concluding: “Putin is a guarantee of war: anyone after Putin is a chance for peace.”

According to Kuleba, any attempts at negotiating with Putin, or pushing for peace, are a waste of time. “The sooner we come to terms with reality, the better policies we can develop to address it,” he said.

He noted that while Europe’s political culture is based on “a win-win approach” in which both sides can benefit, Putin’s outlook is very different: “For him, a solution that benefits both sides is not the best option. For him, the world works on the principle of victory and defeat. One side has to win and the other has to lose,” said Kuleba.

The former foreign minister also warned that Ukraine would face its worst ever winter as Moscow ups its attacks against civilians in a bid to break their spirit.

In recent months, Russian strikes have hit Ukraine’s energy infrastructure and transport links, including bridges over the Dnipro river, as well as homes and civilian sites such as bus stops, schools, postal depots and internet providers. The attacks have disrupted power, transport and daily life as winter approaches.

On Thursday, at least 33 people were killed in a Russian attack on two buses in Kramatorsk in Ukraine’s Donbas region.

Kuleba explained why he believed Moscow has now sharply escalated its airstrikes: “The bombing of cities is a direct consequence of Russia’s failure to defeat Ukraine on the battlefield.” He continued: “The main target of Russian drones and missiles is the Ukrainians’ will to resist — but also the will of Ukraine’s friends abroad to keep supporting it.”

He added:“They don’t just want to turn out the lights in Ukraine. They want to paralyze the country.”

Kuleba described the worst-case scenario in Ukraine as “the collapse of the systems that make life in a big city possible,” such as electricity, water and drainage services.

Could Russia succeed? “I believe Ukraine is too large, too mobile and too adaptable. That’s why I think we’ll get through this winter,” said Kuleba.

“The price will be much higher than last year’s.”

The Axel Springer Global Reporters Network harnesses the resources of the company’s newsrooms to publish ambitious scoops, investigations, interviews, opinion pieces and analysis. It allows journalists — including those from POLITICO, Business Insider, WELT, BILD, Onet, The Telegraph, and Fakt — to collaborate on major stories for an international audience of hundreds of millions across platforms: online, print, TV and audio. 

BRUSSELS — Germany and its allies rebuffed Ireland’s plan to downsize the bloc’s next seven-year budget, arguing that the proposed cuts are not enough.

On Saturday, the Irish presidency of the Council of the EU, which is steering the talks, proposed cutting around 8% from the bloc’s total budget from 2028 to 2034 in a bid to assuage a German-led camp demanding reductions of several hundred billions euros.

But Dublin’s hopes of facilitating a deal were immediately dashed by German Chancellor Friedrich Merz, one the key players in the negotiations as his country contributes to approximately one-quarter of the bloc’s common budget.

“We are still a long way from an agreement. The amount of the new proposal is not a basis for an agreement. The EU budget must be affordable for those who bear the brunt of the financing,” Merz wrote in a statement on Saturday.

Germany leads a group of six “frugal” countries — Sweden, Denmark, the Netherlands, Finland and Austria — which contribute 40% of the Union’s common budget.

Most frugal countries criticized Ireland’s proposed €159 billion in cuts in current prices from the Commission’s nearly €2 trillion proposal, saying they were insufficient.

Sweden’s Europe minister Jessica Rosencrantz described the negotiating document, or negobox, on X as a “wildly unaffordable increase,” as the overall amount would still be higher than the current budget.

Austrian Europe Minister Claudia Bauer echoed that criticism, saying that the new budget remained “miles away from an Austrian yes.”

Tensions will come to a head during a summit of EU leaders next Thursday and Friday, where they will discuss the negobox.

EU governments are racing to reach a budget deal among themselves by the end of the year — before elections in France, Italy and Poland in 2027 threaten to derail negotiations.

But Dutch Finance Minister Eelco Heinen warned on Saturday that “at this rate, there will be no deal by the end of the year.”

Ireland’s Minister of State for European Affairs Thomas Byrne, who leads the negotiations, dismissed criticism and described the proposal as a balanced compromise.

“The negotiating box acts to bridge the many differences between the Member states,” Byrne told reporters on Saturday.

Divided Union

The EU is split between frugal countries pushing for cuts across the board and a rival camp of southern and eastern states, the Friends of Cohesion, opposing reductions to farmers’ subsidies and regional payouts known as cohesion policy.

These areas account for almost half of the total budget and are politically sensitive because of pressure from farmers’ lobbies and regions.

In a concession to the 17 Friends of Cohesion, Ireland left the agriculture and regional budgets untouched and focused cuts on other priorities such as competitiveness, defense and development aid.

“There was a strong support for heading one [agriculture and cohesion] from almost all of the member states, including some of the countries who would be considered to be net contributors” to the budget, Byrne told reporters.

Reactions to the negobox from the Friends of Cohesion were more conciliatory than those of their frugal peers.

“It’s an excellent starting point to have recovered the money for the CAP [Common Agricultural Policy], but we’re still not satisfied,” said Italy’s Agriculture Minister Francesco Lollobrigida.

Poland’s Europe minister Ignacy Niemczycki welcomed the fact that his country “continues to receive the largest allocation,” but noted that the “change in the overall size of the budget does not match the EU’s ambitions.”

The frugals were also are disappointed that the cuts disproportionately target innovative policies such as defense and competitiveness, which they favor.

“They’re cutting the future to protect the past,” said one EU diplomat from the frugal camp.

In 2019, Durham, North Carolina's Can Opener Bridge, formerly with 11 feet, 8 inches of clearance, was raised to 12 feet, 4 inches, reducing but not eliminating the entertaining and completely preventable shearing off of roofs and air conditioning units. — Read the rest

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