"Death by a Thousand Cuts"

Lingchi, or "death by a thousand cuts," was a historical form of execution practiced in parts of Southeast Asia. This method involved methodically removing small portions of the body with a knife over time, leading to eventual death. In a metaphorical sense, the term has come to describe the gradual destruction of something—such as a business—through a series of small, seemingly minor problems that accumulate over time to catastrophic effect. But what happens when this concept is applied to public policy? Could slow decision-making and incremental missteps lead to a similar fate for institutions or nations?

Let’s take European healthcare legislation as an example

Cast your mind back to 2020: the world was in the midst of a pandemic, Joe Biden had just been elected into office, the Tokyo summer Olympics were postponed, and many discovered the joys of working from home—wearing pyjama bottoms all week, dressing in work attire only from the waist up. Fast forward to now: the pandemic has ended, Biden is no longer in office, we've had the Tokyo and the Paris summer Olympics, and working from home is, quite frankly, not all it’s cracked up to be

Yet, amidst all these changes, one thing has not moved forward that much: the eagerly anticipated EU pharmaceutical legislation. This legislation, part of the European Commission’s Pharmaceutical Strategy for Europe, was unveiled in November 2020 as part of that strategy, with the goal of boosting Europe's competitiveness and improving healthcare outcomes. Originally expected to be completed by 2023, it now won’t be fully adopted until late 2025, or even 2026. That's right—2026. Then we have the period of implementation. That is a long time

When you consider that Beijing Daxing International Airport in China was completed in under five years, the contrast with European projects is striking. Then again, the nearly 14-year construction saga of Berlin Brandenburg Airport suggests that such delays might simply reflect the European norm—a modern day metaphor for the continent's struggles with inefficiency and inertia

So how did we get here?

The delays stem from several key factors:

• The complexity of the proposals, which aim to balance innovation incentives, drug accessibility, medicine shortages, and new environmental and safety standards
• Constant wrangling between EU member states who have vested and conflicting interests
• The need for consultation with a wide range of stakeholders—pharmaceutical companies, regulatory bodies, patient advocacy groups, and member states
• And of course, the usual back-and-forth between the European Commission, Parliament, and the Council on contentious issues such as market exclusivity, rare disease treatments, and the environmental impact of pharmaceutical production

Needless to say, consensus has been hard to come by, and we all get that. But, whichever way you look at this, it ain’t good

A pressing urgency for a new approach

The "Draghi Report," authored by Mario Draghi (former Prime Minister of Italy and ex-President of the European Central Bank), published in September 2024, critiques the EU’s declining global competitiveness. It argues that reversing this trend will require not just financial investment but also sweeping policy coordination and regulatory reforms. Central to these reforms is reducing bureaucratic obstacles and fostering stronger collaboration between EU member states

The emphasis on cutting red tape and enhancing unity across Europe is a crucial takeaway here. As the US and China continue to solidify their dominance without let up, Europe must act decisively to remain relevant. Faced with long-term decline and rising political volatility at home, European institutions should feel an urgent need to streamline legislation and implement reforms—or risk an irreversible erosion of influence, a "death by a thousand cuts."