Brexit Threatens UK’s Drug Supply... And More

"Close the wall up with our English dead", King Henry V urged his troops during the British siege of the French port of Harfleur in 1415. As the UK government plunges headlong into another battle on what it still appears to regard as enemy territory, it is hard to resist the sensation that the rhetoric of that Shakespearean hero is informing much of the Brexit thinking in Westminster. 

Certainly, for medicines supply, the current prospects of Brexit are alarming. And if the prospect of "English dead" is not yet on the horizon, the negative implications for patients are evident if Theresa May and her nationalistic cohort pursue their present course. The now-public plan to go for a so-called "hard Brexit" (with the even more radical fallback that "no deal is better than a bad deal") automatically condemns the UK to outsider status in political, economic and trade terms with the 27 countries that will continue to function as the European Union. The revelation in mid-March by the principal minister for Brexit, David Davis, that he has done no planning for a "no deal" scenario, underlines just how irresponsibly feckless the government approach is.

For patients, taking the UK out of the EU's single market, and out of the arrangements that allow goods and people to flow across it, will make it harder for UK health services to import the many medicines that are not produced domestically. It will make it harder for UK drug firms to export their products-hitting not only UK trade and business activity, but also the UK's attractions as a place to invest and locate. The UK departure also means cutting it off from the networks of life science collaboration-to say nothing of a lot of EU research funding-that make it so successful in developing new medicines. Add to that the disincentive that companies and research institutes will face with new barriers in recruiting and retaining highly-qualified staff from the pool of the 500 million citizens who will remain in the EU.

Losing the European Medicines Agency will be another blow, because the agency's presence in London since it came into operation 20 years ago has kept the UK at the centre of European regulatory thinking, and given UK regulators, researchers and companies unrivalled access to the best and brightest as regulatory science has converged across the world. The EMA's impending relocation also powerfully symbolizes the isolation that UK regulators and companies will suffer as marketing authorizations that once had pan-EU force are invalidated. Companies everywhere face being obliged to obtain separate authorizations for the UK through a new system-a system that has to be created from scratch in a timetable measured in months.

The list of challenges grows longer as the survey of the Brexit implications for medicines becomes more detailed. There is no meaning in the government's empty boast about making Britain 'one of the best places in the world for science and innovation' if there is no plan as to how to do it.  Simplistic ideas about UK membership of the European Economic Area or similarly imprecise off-the-peg solutions merely demonstrate-as Mogens Peter Carl, an EU negotiator for 30 years, expressed it recently-"the degree of ignorance about Brexit". And vague reassurances from officials and ministers about transitional arrangements and continued regulatory cooperation remain nothing more than aspirations.

And in the current heady atmosphere as the May government heads unchecked and unchallenged into negotiations, the chances of those aspirations being met are more and more remote.  Because any arrangements to soften the inevitable blow of Brexit depend not on the confidence of the UK negotiators, but on the willingness of 27 other countries to offer concessions to the EU. The central dynamic of this process is not that the EU wants to leave the UK, but that the UK has chosen to leave the EU. The Brussels view is firmly that it is for the UK, as the instigator of the process, to plead for arrangements to ease its pain, and not for the EU to volunteer remedies for ills of the UK's own making. As the UK legislation enabling withdrawal from the UK was adopted in London, a senior Commission official remarked: “Brexit means Brexit. It does not mean the new relationship with the EU, to use Mrs May’s quote."

The hard-line Brexiteers are nevertheless evidently still inebriated by the spirit of an earlier age, and are doubtless quoting approvingly to one another:

"Now set the teeth and stretch the nostril wide,
Hold hard the breath and bend up every spirit
To his full height. On, on, you noblest English."

But to avert the worst-case scenario-what might inelegantly be described as the UK falling flat on its face and shooting itself in the foot by overplaying its hand - the UK government needs to start exploring accommodations with its negotiating partners on cross-border trade, on regulatory alignment, on freedom of movement of researchers, on maintenance of patent and trade-mark protection, and on a dozen other key issues. And if that means some acceptance of unwelcome constraints in the broader interests of patients, then the government should have the maturity to act accordingly. To preserve anything like normal service, the UK needs to make deals, and making deals means some readiness to make concessions, to recognise that not everything can work out precisely as the UK wants it.

That is why mediaeval rhetoric has little place in the current predicament. Theresa May is perhaps susceptible to those ringing phrases of that long-departed (and ultimately unsuccessful) king:

"When the blast of war blows in our ears,
Then imitate the action of the tiger;
Stiffen the sinews, summon up the blood,
Disguise fair nature with hard-favour'd rage;
Then lend the eye a terrible aspect."

But we are not in a time of war – and nor should anyone wish for that. Instead, the government would do well to pay heed to Henry's other injunction: 

In peace there's nothing so becomes a man
As modest stillness and humility.

And UK cabinet papers relating to Brexit should be required to carry a banner heading, reading: "The earlier instructions about setting the teeth and stretching the nostril wide, etc. are no longer to apply to our approach to Brexit negotiations."