Features

Will Brexit be bad for our health?

05 June 2018

As the implications of the UK’s departure from the EU become clearer, journalist Juliette Astrup examines what happens to medical research, as fears are raised that the end of an EU-wide approach could harm patients and public health.

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With Brexit drawing nearer, the medical, research and public health sectors are raising their voices ever louder over the need to protect the health of the nation.

Britain is a world leader in the development of therapies and medicines. Patients here, as well as those across the rest of the European Union (EU), gain much from the close cross-border collaboration by medical researchers and health professionals working to understand diseases and develop new treatments.

For example, between 2004 and 2016 the UK collaborated with other EU countries on almost 5000 clinical trials (Varnai et al, 2017). And research has shown that when the UK and other EU countries work together, the medical research publications have a bigger impact, and are cited far more than those produced in isolation (Varnai et al, 2017).

But what will the landscape look like after Britain leaves the EU?

 

Areas of concern

The Brexit Health Alliance, which unites the NHS, medical research, industry, patients and public health organisations, has highlighted several problematic areas. Chief among them is the question of whether UK researchers will still be able to receive funding from and contribute to EU programmes when the UK leaves.

There is also the potential for Brexit to bring about a divergence with EU regulations, disrupting UK patients’ access to pan-European clinical trials, new drugs and treatments.

The Alliance wants to see our continued participation in the expertise-sharing European Reference Networks, a new model for harmonised regulation and collaborative research and funding. It is also urging politicians to ensure that the UK immigration system remains open and straightforward enough to attract talented researchers and innovators.

 

Continuing cooperation?

Niall Dickson, co-chair of the Alliance, says it is absolutely vital that different organisations and institutions are able to cooperate with each other.

‘Research is a very interdependent process. And over the last 30 or 40 years, we have become much more dependent on our European colleagues, as they have become more dependent on us.

‘The Brexit Health Alliance wants to see, as far as possible, alignment between our regulatory systems and those of Europe. We want to see preserved levels of cooperation on a whole range of areas, particularly on rare diseases. And we want to see the UK plugged in to the research process.’

For those with rare diseases, where there may be just a handful of patients in each member state, Brexit could mean isolation for the UK from wider patient communities and from medical expertise that is scattered across Europe.

As Aisling Burnand, chief executive of the Association of Medical Research Charities, puts it: ‘Only by multinational collaboration can we involve sufficient numbers of children and adults with rare and less common diseases in clinical trials.’

 

Put patients first

The Alliance is not alone in voicing concern. Calls to put patients first resound on both sides of the Channel.

Representing patients across the UK and Europe, 11 organisations wrote an open letter to Brexit negotiators David Davis and Michel Barnier in March, warning of the risks of drugs getting stuck at borders, regulatory systems for medicines splintering and research collaborations stalling.

One signatory, Derick Mitchell, chief executive of the Irish Platform for Patient Organisations, Science and Industry, says: ‘Any future regulatory alignment must ensure sufficient and timely supply of medicines and medical devices. It must not exacerbate delays in access to the most innovative treatments for patients. In the interests of patients and public health, patient voices should be heard loud and clear by negotiators on both sides.’

As negotiations have continued into their second phase in recent weeks, so too has the pressure from the health sector, with 54 medical royal colleges and health organisations backing a ‘Do No Harm’ amendment to the EU (Withdrawal) Bill, tabled by Lord Warner, to ensure that the public’s health is protected after Brexit.

When it was debated in the House of Lords at the end of April, welcome reassurances were offered that the bill, as it is currently framed, already provides adequate legal safeguards to prevent vital public health legislation, policy and practice being diminished as we leave the EU.

There are many indications that the value of international research collaboration is being recognised too. In April in the House of Lords, government whip Baroness Goldie offered the Lords ‘strongest possible reassurance on the UK’s commitment to implement the EU Clinical Trials Regulation’.

And in her Mansion House speech on 2 March, the prime minister said the UK is ‘committed to establishing a far-reaching science and innovation pact with the EU, facilitating the exchange of ideas and researchers’.

She also specifically stated her aim that Britain will remain part of the European Medicines Agency, meaning continued investment in new medicines, and their faster delivery to patients.

 

Reality check

However, the signs of that becoming a reality are, so far, less than encouraging; the negotiating guidelines adopted by the European Council in March specifically preclude ‘participation of the UK as a third country in the Union institutions and participation in the decision-making of the Union bodies, offices and agencies’.

But there are also reasons to be hopeful, as Kate Ling, a senior European policy manager at the NHS European Office, points out in her blog (2018): ‘The Council say they are committed to seeking a “balanced, ambitious and wide” free trade agreement and go on to list some of the areas they would like it to cover.

‘Encouragingly for the NHS, one of these areas is a “framework for voluntary regulatory cooperation”. There is also specific mention of continued participation in collaborative research and innovation.’

There’s also positive news for the sector in the transition agreement, expected to last until the end of 2020, and the decision that EU nationals already living in the UK and those arriving during the transition period will have the same rights as they do now. And UK researchers will continue to be eligible during this time to apply for Horizon 2020, the largest-ever European funding programme for research and innovation, with a budget of €79bn.

But ‘nothing is agreed until everything is agreed’, as the Brexit mantra goes, so there is likely to be further uncertainty ahead on the road to leaving the EU.

 

Picture credit | Shutterstock


 

References

Ling K. (2018) One year on from Article 50: where are we, and what next for the NHS? See: http://www.nhsconfed.org/blog/2018/03/one-year-after-article-50--where-are-we-and-what-next-for-the-nhs (accessed 17 May 2018).

Varnai P, Rentel M, Davé A, De Scalzi M, Timmerman W, Rosemberg-Montes C, Simmonds P. (2017) The impact of collaboration: the value of UK medical research to EU science and health. See: cancerresearchuk.org/sites/default/files/main_report_v8.pdf (accessed 4 May 2018).

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