How Trump’s attack on diversity could derail drug development in Switzerland

The US accounts for nearly 50% of global revenue for Swiss pharmaceutical firm Roche. Keystone-SDA / Georgios Kefalas

Swiss pharmaceutical companies Roche and Novartis are adjusting goals on diversity and inclusion in response to US President Trump’s executive orders. Experts warn abandoning any diversity goals in clinical research could set drug development back decades.

Global companies with headquarters outside the US are not immune to pressure from US President Donald Trump’s executive orders. Several Swiss companies announced this week that they are adjusting their language and goals on diversity, equity and inclusion (DEI) not just in the US but also at a global level.

Among them, pharmaceutical company Roche is changing its ten-year ambition from “achieve an inclusive environment through global leadership that mirrors our workforce” to “foster an inclusive environment that inspires people to perform at their very best,” a Roche spokesperson told SWI swissinfo.ch in an emailed statement.

The decision comes in response to Trump’s executive orders, specifically one issued on January 21 on “ending illegal discrimination and restoring merit-based opportunityExternal link”. This includes a call to encourage the private sector to “end illegal DEI discrimination and preferences”. 

DEI programmes and policies seek to create workplaces that are welcoming to all people, and address barriers to the representation of marginalised groups, for example in leadership positions. Big companies in the US, and increasingly globally, have embraced DEI in an effort to attract and retain talent, as well as to meet the needs of an increasingly diverse customer base. President Trump has attacked DEI as “woke” culture that he claims leads to unfair treatment of non-minorities.

Amid Trump’s dismantling of DEI, Roche wiped diversity targetsExternal link from the website of its US subsidiary, Genentech, in mid-February. Basel-based competitor Novartis also said this week it was getting rid of diverse panelsExternal link in its hiring process in the US.

Roche’s decision to make changes at a global level are “because our global programs and goals can have an impact on our US organisations if we are not compliant under the new law,” Roche executives said in an email to employees on Tuesday evening, which SWI was able to see.

But the fact that global headquarters in Switzerland are bending to Trump’s demands has raised questions about how far his orders could reach, and whether some of companies’ core activities including drug research and development could be affected.

Insights into how diseases and treatments affect people differently based on their sex, gender, and ethnicity has become important to the development of targeted drugs.

In 2022, Novartis invested $17.7 million (CHF15 million) as part of a 10-year plan to address racial inequalities in clinical trials. A year earlier it set up the Beacon of HopeExternal link initiative to collaborate with 26 historically Black universities in the US.

Novartis told SWI by email that it remains committed to Beacon of Hope, and that it will continue to invest in “diverse patient representation in clinical trials as it is critical to our R&D efforts”.

Roche echoed these sentiments. In its 2024 annual report, the firm wrote that it is embedding “DEI into every aspect of our pharmaceutical and diagnostic research, development and solution delivery”. It also wrote that it had an entire “team dedicated to supporting inclusive research”.

In a response to SWI, a Roche spokesperson said that its US subsidiary’s inclusive research will “continue to focus on designing studies that include patients across various races, ethnicities, and ancestries to ensure that clinical trials reflect the broader patient population”.

There remains a lot of uncertainty though. In the email to employees, Roche executives wrote that “moving forward, there will be changes to DEI content, activities and programmes” both in the US and globally.

The long-term harm

Experts who spoke to SWI warned that it will be patients who ultimately suffer from any retreat on diversity in drug development.

“Not considering sex, gender and race in research of new medicine isn’t just bad science; it’s negligence,” said Antonella Santuccione Chadha, a pathologist and neurologist who worked at Roche and Biogen from 2018-2022 and is now the head of the Women’s Brain Foundation based in Zurich.

In the past 40 years, medical products have been 3.5 times more likely to be removed from the market because of adverse effects on women than on men, according to a McKinsey Health Institute studyExternal link published last year.

It wasn’t until 1993 that the US Food and Drug Administration even allowed women of child-bearing years to participate in early trials. Over the past decade, a number of medicines regulators, including in SwitzerlandExternal link, have created guidance, toolkits and standards for more diversity in clinical trials.

The importance of expanding trials to a more diverse population has also become more pressing in the light of population trends. By 2050, one in four people on the planet will be African, up from 1 in 11 in 1960, according to the United Nations. Currently, despite Africa comprising over 16% of the world’s population and shouldering 25% of the global disease burden, only 2% to 4% of global clinical trials are conducted on the continent.

The impact and consequences of a retreat on diversity would be “tangible and scary”, said Claudia Vaccarone, a consultant on inclusive strategies. This would impact the “study and development of drugs and devices specifically addressing health issues of women and minorities”.

Under pressure

There are already signs that diversity and inclusion in medical research will come under pressure from the Trump administration.

In the first week after the US president was sworn in, several External linkfederal webpages on diversity in research were removed, including draft guidance for drug and device makers on under-represented populations for late-stage clinical trials that was set to be finalised in 2025. The guidance was since restored but it is still unclear what will remain of existing efforts, and what shape they will take.

Bloomberg reportedExternal link in February that the US-based pharmaceutical company Bristol Myers Squibb Co. removed goals on diversifying clinical trials in its 2024 annual report.

The US remains the most important pharmaceutical market, accounting for 40-50% of global revenue for Novartis and Roche. The companies also have lucrative contracts with the US government to conduct research and supply medicine, for example through Medicare, the national health insurance programme for people over 65.

“Companies need rules, guidance and even incentives to ensure trials reflect the population they are trying to serve,” said Chadha. “It’s not the time to go backwards.”

Edited by Virginie Mangin/dos