Trump visit sparks record US pharma pledge as UK fiscal headwinds intensify

During Donald Trump’s state visit to Britain, AstraZeneca and GSK unveiled a combined £59 billion of planned investment in the United States over the next five years, while spending in the United Kingdom is effectively on hold. The deal underscores a broader realignment of global trade patterns in response to the war in Ukraine and tariff policies, with big pharma doubling down on its largest markets.

GSK earns more than half of its income in the United States, and AstraZeneca also flags the United States and China as its primary growth engines. Britain, where the companies generate a small fraction of revenue — less than 2% for AstraZeneca — is comparatively less important to their global strategy despite substantial investments in UK research labs at universities such as Cambridge, Oxford and York. The announcements came as industry leaders argued for a more predictable UK policy framework and for a pharma strategy that could translate into tangible benefits for patients and researchers at home.

There is growing frustration with the National Institute for Health and Care Excellence (NICE), which assesses value for money for taxpayers. The debate centers on access and pricing in the NHS, with industry insiders pointing to a 27% rebate demanded by Health Secretary Wes Streeting for branded medicines, up from 15%, as a non-starter for many manufacturers. The sense among some observers is that a published pharma strategy has for now failed to deliver meaningful reforms, even as the U.S. investment cycle accelerates and U.K. policy questions linger.

AstraZeneca has highlighted the patchwork of access to medicines within the U.K., noting that some therapies developed in Britain are not uniformly available across the country. For example, a breast cancer drug from AstraZeneca is available in Scotland but not England, and a prostate cancer treatment linked to Zytiga has seen limited availability in parts of the U.K. at various times. Astra’s lupus treatment, announced as ready for market, underscores ongoing questions about whether British patients will benefit from new medicines under the current pricing framework.

Industry voices argue that even if a political compromise on NHS rebates were reached, the broader damage to Britain’s life sciences ecosystem could be lasting. Labour’s proposed life sciences agenda, viewed by some as a potential pillar of a future policy framework, appears to have stalled amid fiscal concerns and shifting market priorities. The immediate mood in Westminster and among industry executives is that the reform path is more challenging than anticipated, and that the U.K. faces a difficult longer-term balance between public health spending and research investment.

The fiscal backdrop in Britain intensified the disruption. Five months into the current fiscal year, borrowing reached £83.8 billion, about £11.4 billion above forecast. Tax rises totaling around £40 billion implemented last year have done little to cool inflation, while borrowing costs have risen and the national debt has grown. In financial markets, the pound slipped against the dollar and government bond yields moved higher, signaling growing concern about the growth outlook and the sustainability of the government’s plans. While there is no sterling crisis, a weaker currency and higher yields could restrain consumer spending and business investment amid continued policy uncertainty.

Forecasting public finances remains notoriously unpredictable, and some forecasters warn that productivity projections could be revised downward as the Budget approaches on November 26. Against this backdrop, markets have been wary, though retail sales data still show pockets of resilience, suggesting that consumer confidence has not collapsed entirely.

In a separate development, private equity house Apollo — once associated with high-profile fundraising and, controversially, with linked reputational concerns — has entered advanced talks to acquire Atletico Madrid for about £2.2 billion in a debt-fueled deal. The transaction illustrates a broader pattern of leveraged takeovers in European football, a sector whose owners are under scrutiny for the sustainability of debt levels and the long-term implications for clubs’ operations and fan engagement.

Separately, the market for do-it-yourself investing platforms continues to expand. Major platforms such as AJ Bell, Hargreaves Lansdown, interactive investor, InvestEngine and Trading 212 compete for retail investors with varying fee structures and product offerings, underscoring the growing role of online trading in everyday investing. As the sector evolves, investors are watching how platform choices interact with evolving market volatility, record-keeping requirements and regulatory oversight.

The juxtaposition of a high-profile international investment pledge in the United States with a tightening UK fiscal environment and a shifting global investment landscape highlights how business and markets are navigating a era of fragmented supply chains, policy risk, and divergent national priorities. While the U.K. faces a tough near-term path, the long-term trajectory for pharmaceutical innovation remains tethered to funding, access policies, and the ability to translate research into patient care. Analysts say a path toward greater policy clarity and investment incentives could help restore confidence, but for now the balance between public health spending, tax policy, and market expectations remains delicate.