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The pharmaceutical industry is framing itself as a key partner for President Trump and HHS Secretary Robert F. Kennedy Jr. in their quest to alleviate America's chronic disease burden.

• The problem: Kennedy doesn't seem to be buying it.

Why it matters: One of America's most powerful industries is in uncharted territory. It's now in the position of convincing critics that its products are not just safe, but crucial to solving the country's diciest health problems.

Driving the news: The PhRMA forum, held this week at one of D.C.'s coolest concert venues, featured a stream of not-so-subtle indications that the industry wants to make the case that the best way to reduce the country's chronic disease burden is to find more and better drugs to treat chronic conditions.

• Attendees received name tag lanyards with the event's slogan — "Commitment to a Healthier America" — printed at the top.
• While speakers hit on familiar policy goals, such as cracking down on pharmacy benefit managers and removing the government's hand from pricing, there was a lot of talk about how to keep people out of hospitals through more preventative care.

Pharmaceutical leaders kicked off Kennedy's tenure at the helm of HHS not with defensiveness or aggressiveness, but with declarations of optimism and mutual goal-sharing.

• "We have a disruptor-in-chief in President Trump and a new HHS secretary — both of which are committed to overturning the status quo," PhRMA president and CEO Steve Ubl said in his remarks at the industry group's policy forum this week.
• "We embrace disruption because we are disruptors," he added. "We see an opportunity to fix what's broken, to get more impact out of every health care dollar we spend and to make America healthier by launching a new era of medical innovation."
• "What we need to do is keep people well," GSK CEO Emma Walmsley told me in an offstage interview. "Making the country healthier is a really good idea. But people should see the drug industry not as the enemy in that, but as part of the solution."

And speakers made it blatantly clear that former President Biden was bad for the industry, while Trump has the potential to be very good.

• "I truly believe that the opportunities truly outweigh the risks," Pfizer CEO Albert Bourla told the crowd.
• While a big partnership on vaccines is "probably not" in the cards, such a partnership on cancer or chronic disease could "absolutely" happen, Bourla added.

But at nearly the same time, Kennedy's welcoming remarks to HHS staff threw some cold water on the idea of an intimate partnership.

• After a long list of chronic disease statistics, he said, "Our only solution to these issues seems to be more and more pharmaceutical interventions that don't seem to be alleviating the problem, and in many cases, appear to be worsening it. Overmedication, particularly in children, is a growing issue."
• As has been widely reported, the childhood vaccine schedule and psychiatric drugs were both on Kennedy's list of possible contributors to chronic disease that will be investigated.
• "Secretary Kennedy put PHARMA on notice that solutions to the chronic illness epidemic are going to be found upstream through prevention not through pharmaceutical interventions," texted David Mansdoerfer, a former senior HHS official in the first Trump administration.

An assessment of the threat posed by psychiatric and weight-loss drugs was also ordered in a recent executive order from the White House this week establishing a "Make America Healthy Again Commission."

• Just yesterday, the first meeting of the CDC vaccine advisory committee since Kennedy's confirmation was postponed, creating more consternation over how Kennedy will approach vaccines as secretary.
• HHS also ordered the CDC to shelve some vaccine promotions, saying Kennedy wants ads that feature "informed consent" in vaccine decision-making instead, STAT reported later yesterday.
• And Kennedy is planning to replace members of vaccine advisory committees that he perceives to have conflicts of interest, Politico reported.

Drug company and PhRMA executives once again met with Trump yesterday, though to what avail is unclear.

• "PhRMA president and CEO Steve Ubl and members of our board had a productive conversation with President Trump today. We expressed our commitment to strengthening American leadership in biopharmaceutical innovation, revitalizing domestic manufacturing and lowering costs for patients," said Alex Schriver, PhRMA's senior vice president of public affairs.

Reality check: Yes, the drug industry hates that Medicare now negotiates the prices of some drugs. But the new law has, so far, failed to cause much of a hit to big drug companies' finances, and there is plenty of reason to think things may actually get worse for the industry under the Trump administration.

• Put aside Kennedy's vaccine history, he and Trump have both been critical of the fact America pays so much more for drugs than other wealthy countries.
• If that criticism ever turns into meaningful policy, it could hit the industry way harder than Biden's Medicare negotiations.

For too long, Big Pharma has lined its pockets at the expense of Americans — keeping drug prices high in the U.S. and lower in other wealthy countries.

The impact: While they protect their profits, Americans struggle.

Why are we getting a bad deal?

If optimism about a healthier future is the carrot pharma is offering the Trump administration, the threat China poses to America's biotech industry is its stick.

Between the lines: Industry leaders spelled out in clear terms that without support, the U.S. will cede its lead in biomedical innovation to China — and pretty soon we'll all be taking Chinese drugs.

• The language unmistakably dovetails with Trump's America-first rhetoric and more bipartisan concerns about the rise of Chinese global power.
• "I think we should prioritize what we have in common, which is to lead with American-born innovation. You don't need to be an American company; you need to be American committed," GSK's Walmsley told me.

What they said: "Practically nonexistent 10 years ago, China's medicine pipeline is now the fastest growing in the world. If trends continue, they will surpass the U.S. by the end of the decade," Ubl told event attendees.

• "Public policy is the single most important factor to our future," he added.
• "I'm afraid if we don't do something to change the course, pretty soon in the next three to four years, we will see Chinese innovation to dominate the medical field," Bourla said.

The big picture: China has quickly ratcheted up its competitiveness in the biotech sphere, and the WSJ recently reported that "a decade from now, many drugs hitting the U.S. market will have originated in Chinese labs."

• But pricing-related U.S. policy isn't the only factor at play here. Attracting and retaining top talent is also important, and there's concern that some of the Trump administration's actions — such as its policy capping NIH reimbursement for indirect research costs — could contribute to brain drain.
• Citing an opinion leader, an analyst note from Leerink Partners on the NIH cut wrote that "biomedical research already faces rising costs and stagnant NIH grant support, while China and other international institutions are increasing investments in life sciences. [The opinion leader] suggested that a prolonged reduction in U.S. research funding could lead to more drug discovery and biotech innovation occurring abroad."

Trump's tariffs could also prove difficult for the industry to navigate. He said Tuesday he plans to impose 25% tariffs on some products — including pharmaceuticals — shipped to the U.S. as soon as this spring.

Americans are getting a bad deal on drug prices — paying approximately 10 times more for drugs like heart medications than consumers in Europe.

Congress and the Trump Administration should hold Big Pharma accountable for making prescription drugs unaffordable.

Thanks to Nicholas Johnston and Adriel Bettelheim for editing and Cindy Orosco-Wright for copy editing.