Health threats fail to respect international borders – tackling them effectively requires joined-up policies and action, writes Kate Ling.
- new strain of antibiotic-resistant disease appeared in the UK, but we realised too late…
- we hadn’t stockpiled enough medicines to deal with a flu epidemic, or with a threat like Ebola…
- patients were harmed because we missed warnings about a drug’s dangerous side-effects…
- patients waiting for organ transplants had to wait for a UK donor…
These scenarios may sound far-fetched, but they could become a reality after the UK leaves the European Union (EU) unless both sides wake up to the need to make citizens’ health a priority in Brexit negotiations.
Health threats across borders
Take threats from infectious diseases, for example. Currently the UK belongs to an agency, the European Centre for Disease Prevention and Control (ECDC), which coordinates EU-wide systems for exchanging early warnings and intelligence about new strains of disease, epidemics and emergencies.
National bodies such as Public Health England work closely with the ECDC to monitor emerging threats, tap into expertise across the continent and take swift and robust action to combat the spread of communicable diseases.
It seems blindingly obvious that it is in everyone’s interests on both sides of the Channel to maintain these valuable links. Health threats don’t respect borders – tackling them effectively requires joined-up policies and action.
But there’s a danger that in the give and take of negotiations about the UK’s future relationship with the EU, issues like this can get lost or side-lined because they are not top of the agenda.
The ECDC, for example, is only one of many EU agencies to which the UK belongs because it is an EU member state. Another example is the European Medicines Agency (EMA), which approves medicines for marketing across the EU, including the UK. In the event of a ‘hard’ or ‘no deal’ Brexit, we could find ourselves facing delays or shortages of drugs if we are unable to import the medicines we need from the EU in time, because the UK is no longer part of this system.
Will the Brexit deal protect citizens from these threats?
The UK’s Secretary of State for Health has clearly stated that we want to “find an agreement that allows us to maintain the important and mutually beneficial collaboration with Europe on health issues”. The EU has also said it wants to continue close collaboration in these areas.
But public health doesn’t even feature on the list of topics for discussion in talks on the future framework for the new relationship between the UK and EU. Health is only one of the many issues in the frame when negotiating how much access the EU will retain to various EU agencies after Brexit.
The recent speech in Lisbon by Michel Barnier, the EU’s chief negotiator, does not give much cause for encouragement – he reiterated that: “It is one thing to be inside the Union, and another to be outside”, and that the UK will be outside the Single Market and treated as a third country.
So we cannot assume that the UK will get access to everything it wants, even in areas where it makes sense to everyone to continue to collaborate.
Take another example: the EU sets stringent safety standards about the quality and safety of human cells and tissue, including blood products and transplant organs. This means that currently UK patients can receive transplant organs from EU donors and vice-versa, because everyone meets the same standards. But if in future the UK no longer abides by the same rules, this would not be possible.
And beyond Brexit?
We do not know yet what kind of trade deals the UK may strike with other countries after leaving the EU. But the healthcare community in the UK, including medical royal colleges and faculties, NHS bodies and major charities such as Cancer Research UK, Diabetes UK and MIND, successfully campaigned recently for the UK Government to commit to a high level of human health protection in all future policies and activities, which would mean not watering down safety, quality and environmental standards in future trade agreements.
The Brexit Health Alliance’s 'asks' on public health
The Brexit Health Alliance – an alliance of organisations representing healthcare users, commissioners, providers, researchers, educators and the healthcare industries – has run several campaigns highlighting the possible impact of Brexit on different aspects of healthcare, such as medical research or access to medicines.
Our new campaign, launched at the NHS Confederation’s annual conference in June, focuses on protecting the public’s health after Brexit.
Our briefing calls for:
- both the EU Commission and UK Government to prioritise the public’s health in negotiations on the future relationship between the UK and the EU
- strong coordination between the UK and EU in dealing with serious cross-border health threats, such as pandemics, infectious diseases, safety of medicines (pharmacovigilance) and contamination of the food chain – ideally, this would be by continuing access to the ECDC and other relevant EU agencies, systems and databases
- alignment with current and future EU regulatory and health and safety standards relating to, for example, food, medicines, transplant organs and the environment, to avoid the need for replication of inspections and non-tariff barriers at the UK/EU border
- the UK Government to commit to a high level of human health protection when negotiating future free trade and investment agreements.
As one public health expert said recently: “Microbes don’t need visas to enter the country, and you can’t build a wall to keep them out!”.
Kate Ling is a senior policy manager at the NHS European Office, part of the NHS Confederation. Follow the organisation on Twitter @NHSConfed_EU.
If you're attending Confed18, pick up a copy of the briefing at the NHS Confederation's stand, FA6.