Nick Fahy and Mark Dayan / Jul 2024
Image: Shutterstock
Faced with the Covid pandemic, policy actions on health were taken that were previously unthinkable, in both the EU and the UK. Collective purchasing of drugs and devices and unprecedented EU-level cooperation all highlighted what could be achieved, and left a legacy of far more ambitious action for health at EU level, even if the subsequent pressures of the war in Ukraine have led to some retrenchment. Meanwhile, the UK has faced similar challenges but without the scale of response of the EU. Following the elections in both the EU and the UK, could health be an area to begin renewing closer cooperation?
In our Health and International Relations Monitor project, funded by the Health Foundation, we track and monitor the impact of Brexit. Leaving the EU has had impacts on all the principal components of health systems, and almost all unhelpfully. But what is becoming more apparent from our analysis, and the experts and officials we interview, is that greater UK-EU cooperation has the potential to help. Ultimately, many of these problems are shared across Europe at a time when medical supplies, science, and the health and care workforce are less constrained by borders than ever before.
Problem shared, solutions separated
Medicine shortages are one clear example of a shared challenge. Shortages in the UK are at a striking and concerning peak, having a direct impact on patients. Though many European countries face difficulties too, with Italy and Germany both seeing sharp spikes in disruption in 2023, Brexit has added to the issues in the UK. Despite Great Britain continuing to voluntarily recognise EU regulatory approvals, new customs requirements at the border have introduced a divide between the two markets, and trade volume has been suppressed. There is already a degree of cooperation between the EU and the UK on the issue, with the UK taking part in the Critical Medicines Alliance convened by the European Commission, which could provide a basis for greater cooperation in the more formal initiatives being taken by both the UK and the EU.
More broadly, despite the rhetoric at the time of Brexit of ‘Singapore-on-Thames’, promulgating a low-tax, lightly regulated deliberate divergence of the UK from the EU, this has been strikingly absent in reality. Our research has shown that in practice, the UK has not actively diverged from the EU in its regulation of health-related products and services. There has been a degree of passive divergence of the UK from the EU because of the EU’s continued efforts to improve the regulatory environment for health-related research, such as through the ACT-EU initiative on Accelerating Clinical Trials in the EU. There have also been efforts to diverge around standards, though in the end the UK has continued to accept the EU’s CE marking.
The UK’s main change in medicines regulation has been the introduction of the Innovative Licensing and Access Pathway (ILAP) where its national cost-effectiveness assessment is carried out alongside approval of new drugs, speeding up the introduction of some selected products. But this is compatible with EU rules and was introduced under their inherited forms. Brexit facilitates it only insofar as the UK must now do everything at national level, bringing the two processes to the same level.
Perhaps the only major health-related area of deliberate divergence in actual regulatory standards is around artificial intelligence, where the UK has consciously avoided the kind of the overarching regulatory framework set out in the EU’s AI Act, though there is plenty of regulation at the level of sector and specialised agencies.
On the one hand, this illustrates that the idea of deliberate divergence by the UK in health-related regulation has not been realised in practice. On the other hand, this limited degree of divergence in practice means that efforts to renew cooperation and actively ensure alignment would not have that great a gap to bridge, which would help their feasibility.
Where could more cooperation be possible?
Following the elections in both the UK and EU, a new political period will present real opportunities to work together more. The Labour party now in government in the UK is committed to improving the UK’s relationship with the EU, while not seeking to rejoin as such. One specific area identified is mutual recognition of qualifications - though globally this often does not extend to doctors and nurses, and the UK regulator is consulting on cutting clinical training hours in a way incompatible with EU standards. The party has committed to seeking a “security pact” across multiple measures, which could provide a template for fields such as health.
However, during our research we found that focus on the UK was a long way down the ranking of priorities for many in Brussels, and where it did exist, often tinged with suspicion from years of hostile negotiating where the UK at times threatened to break its treaty commitments. There are also broader areas which emerge from our research as areas of potential mutual benefit, such as information and preparedness against threats to health, making best use of expertise on rare diseases across the UK and the EU through European reference networks. On the specific challenges of medicines, there is potential advantage to both the UK and the EU in re-establishing the mutual recognition of batch testing, which the EU and UK do for many other jurisdictions, and maximising the collective European market in comparison to other global locations of supply.
Conclusion
Health has often been seen as an area of shared interests and mutual benefits to provide a platform for mutual cooperation between jurisdictions where there are tense relations to manage. Our research suggests that while political space for greater EU-UK cooperation in general may be limited, health offers a range of concrete areas where greater cooperation can help both face specific challenges. With the post-elections potential to reshape relations, might health play this role again for the EU and the UK?
For more on this topic visit The Health Foundation website.
