Policy and politics
How Brexit will affect healthcare, science and research
Should the UK remain a member of the European Union or should it leave? We put two opposing views together to help you decide.
The UK prime minister David Cameron has kept his promise to hold a referendum on whether the UK should leave the European Union (EU) if he won the 2015 general election. The pledge was in response to calls from Conservative Party MPs and the UK Independence Party, which argued that the British public had not had a say on EU membership since 1975, when it voted to stay in. The referendum will be held on 23 June 2016 to decide whether the UK should stay or leave.
Courtesy of Martin McKee
Why Brexit will be detrimental to healthcare, science and research
The argument for leaving the EU has been formed from misunderstandings and wild speculation. In reality, there is too much at stake for the UK to leave the EU, says Martin McKee, professor of European public health at London School of Hygiene and Tropical Medicine.
In June 2016, the UK population will be making one of the most important political decisions of its lifetime. The government is keeping its manifesto promise to hold a referendum on membership of the EU. Polls indicate that many people (up to 20%) are still undecided. This is hardly surprising. Despite the importance of European policies, the media has practically ignored the processes by which EU officials work for decades. As a consequence, it has been easy for those who would like the UK to renounce its membership of the EU to speculate wildly and make blatantly false statements. Indeed, there are so many that there is now an extensive fact checking website dedicated to Brexit, www.infacts.org. Examples on the website include the truth about UK borders — anyone queuing to get through passport control at a British airport will know that it controls its own borders, and has refused entry to about 6,000 EU citizens on security grounds since 2010. Similarly, if the EU is “undemocratic”, as critics may claim, people may wonder why they are invited to vote for members of the European Parliament, a body that can and does reject proposals from the European Commission, which like all civil services is “unelected”.
Benefits of membership
As someone who has studied European health policy for 20 years, working closely with the European Commission, European Parliament and national governments holding the rotating EU presidency, I find it inexplicable that we should even be having a debate to leave the EU. The UK has benefited enormously from the free movement of people within the EU. It has facilitated the boom in low-cost air travel that allows people to travel cheaply within Europe. It has also allowed many older British people to retire to a place in the sun, where they can obtain healthcare on exactly the same basis as the local citizens. And the 2011 cross-border care directive means that you can take a prescription issued in one country and have it dispensed in another.
Membership of the EU has made it much easier for the NHS to recruit highly skilled workers from Europe to fill many vacancies, created as a result of our long-term underinvestment in training of health workers. In the past, there have been concerns about the quality of healthcare professionals recruited from other parts of the EU. However, the European Commission has listened carefully and, working with national governments, has established rapid and effective mechanisms to ensure the exchange of information among regulatory bodies.
Professional mobility has been especially important in UK universities, where more than 6,000 life science researchers from other European countries contribute substantially to our ability to innovate and grow the economy, in areas as diverse as drug discovery and health services research. Those who support Brexit argue that skilled workers from the rest of the EU could easily be replaced by others from the rest of the world. However, any new system would inevitably involve a complex system of work permits that would add to the existing and substantial challenges facing the NHS and universities.
Pharma and medicines regulation
The pharmaceutical industry makes a major contribution to the UK economy. For example, the pharmaceutical sector has, over the past decade, generated an ever-widening trade surplus (i.e. more money coming into the UK than going out) of £2.8bn in 2013, according to HM Revenue and Customs. The biggest global pharmaceutical companies have bases in the UK from which they sell into the European market. If the UK were to leave the EU, even if these companies do not relocate completely, it is unlikely that they would continue to invest in a UK separated from its neighbours by a tangle of regulatory barriers.
The European Medicines Agency, based in London, has established a single process for authorising medicines across the EU, with substantial benefits in terms of cost and speed of bringing new products to market. One thing that is absolutely certain is the agency would relocate to somewhere else in the EU if the UK were to leave. However, the cost of duplicating its work means it is likely that the UK would accept the decisions made by the relocated agency. As with so many implications of Brexit, this would mean that we would have to accept decisions made elsewhere without having any input into them.
As might be expected, the Association of the British Pharmaceutical Industry, the trade association for pharmaceutical companies in the UK, takes a clear stance on the benefits of EU membership, noting how the existing processes have “not only greatly simplified the situation but also resulted in a system where medicines information, such as the patient information leaflet, are consistent across all EU member states, which is good for public health protection”. Beyond the EU, the UK pharmaceutical industry benefits from our membership of trade agreements with other countries. Those who support Brexit constantly argue that the UK could negotiate its own deals, achieving better terms. Unfortunately, this view has consistently been rejected by those countries with whom we would have to negotiate, including the United States. Moreover, it is somewhat implausible to imagine that, without much reduced negotiating power, we would get a better deal than the EU, with its populaton of 500 million.
Those who support Brexit have made much of concerns about clinical trials regulation. There is widespread agreement that, in its initial form, the regulation is overly bureaucratic, but this reflects concerns about the need to balance protection for trial subjects with ease of undertaking them. There have been some high profile cases of volunteers dying or suffering severe disability, including one recent tragic incident in France, where one person died and five others were admitted to hospital after a trial went wrong.
In fact, the story of how clinical trial regulation has been revised is one that deserves to be told, because it is a good example of how the EU listens to the concerns of scientists and, in particular, the importance of a strong UK voice. The new regulation has streamlined the administrative processes without compromising the safety of subjects. Charity Cancer Research UK says the approach will “cut red tape” and “help us to beat cancer sooner”, while the AllTrials group of researchers campaigning for improved reporting of clinical trials has described it as “fantastic”, noting how “the efforts of people all over Europe” had ensured that the new regulation met the needs of all of the relevant constituencies. The NHS Confederation, the membership body for organisations that commission and provide NHS services, says the changes will “unleash the NHS’s clinical research potential”.
Another argument that has been misleadingly used against the EU is its negotiation of the Transatlantic Trade and Investment Partnership (TTIP) with the United States, which some people, including myself, have been concerned could threaten the NHS. Yet the EU’s negotiating team has incorporated many of the safeguards that we asked for, including major changes to the investor-state dispute settlement process, ensuring full transparency and the involvement of judges rather than negotiators selected by major corporations.
The spread of counterfeit medicines, with its implications for antimicrobial resistance, is becoming a global health emergency. The EU has been at the forefront of measures to address this problem, creating systems to monitor global supply chains and to share safety information on emerging problems. Again, this is something that the UK could no doubt buy into if it were to leave the EU, but would have little input into the policy.
It is unfortunate that so much of the EU debate has been characterised by so many fundamental misunderstandings about how it works and what it has achieved. Even at its most basic, some commentators seem unable to understand that it is a democratic structure, with laws being made by the elected members of the European Parliament and ministers from the member states. Crucially, there is plenty of evidence that they listen to well argued concerns when problems emerge.
Source: Jamie Martin
Why leaving the European Union will benefit UK science and healthcare
It is time to dispel the myth that Brexit will be detrimental for scientists, healthcare professionals and the pharmaceutical industry in the UK, says Jamie Martin, science policy adviser for Scientists for Britain, a group of scientists who want to leave the EU.
It is a shame that, instead of using the EU referendum to offer a compelling vision for the future, the Remain campaign has chosen to mention science and the NHS only occasionally, and then only to make misleading claims about the consequences of voting to leave the EU. By contrast, Vote Leave is placing science and the NHS at the heart of its campaign, arguing that outside the EU both will see increased funding and a more supportive immigration and regulatory framework.
For the UK’s healthcare professionals and scientists, a vote to remain is to be at great risk from the EU’s worsening regulations and outmoded institutions. EU membership risks reducing the UK’s ability to recruit talented staff from outside Europe, to innovate and conduct trials, and to build partnerships with non-EU universities and firms.
A vote to leave, by contrast, is to a vote to place healthcare professionals and scientists at the centre of a national mission to be the world’s leading country for science and innovation, with regulation, immigration and funding policies that support this goal.
No detriment to science
If the UK leaves the EU, we will continue to be funded by and cooperate in European higher education and science programmes, such as Horizon 2020. Our students will still take full part in the Erasmus scheme (which provides opportunities for students to study or undertake a work placement abroad as part of their degree), because, like Horizon 2020, you do not need to be in the EU to do so. As the participation of just about every country geographically proximate to the EU from Iceland to Israel shows, countries with far smaller populations and an immeasurably smaller science base than the UK get full access to EU science programmes. It is not intellectually serious to suggest a post-EU the UK, Europe’s science superpower, would get anything less.
Indeed, given the benefits leaving the EU might bring for science, the UK may win more Horizon 2020 funding and have a more influential role in the programme. Israel has no political relationship with the EU, but is a net beneficiary to the tune of €1.60 for every €1 it puts in. Despite contravening its own deal with the EU by abandoning free movement following a plebiscite, Switzerland is associated to the main parts of Horizon 2020 and has received more funded projects per capita than Germany, the UK or Spain. Under the last European research framework, in both physical (the Swiss Institute of Technology) and life sciences (Israeli Weizmann institute), a non-EU institution had more projects funded than any UK institution.
Vote Leave is explicitly clear that a post-EU the UK would make science a national focus, using our competitive advantage of world class universities and the NHS, advanced value add industries such as biotechnology and pharmaceuticals, high quality services and London’s attractiveness as a global city with a helpful geographic position and time zone. The result would be what the Leave campaign has called a “meritocratic technopolis” — a global hub of science and innovation that becomes a magnet for people from all over the globe wanting to join like-minded individuals in solving the world’s toughest problems.
Leaving the EU is vital to creating the first pillar in this vision: an immigration policy that welcomes the best pharmaceutical and medical professionals to the UK, irrespective of nationality. The policy enforced on the UK by the EU, where a German who did not complete high school has more immigration rights than the most gifted medical researcher from India or a brilliant doctor from South Africa, is morally and economically flawed. We need a policy that is blind to where candidates are born but focused on bringing the best scientists and medical staff from Asia, Africa and the Americas, as well as Europe, to the UK. We can have, as the United States does, an automatic postgraduation visa for science, technology, engineering and mathematics graduates. This new, more open immigration approach will open up more mobility opportunities for UK pharmaceutical and medical professionals. Free of the need to give European students of all disciplines preferential fee rates, universities can instead divert this funding to scholarships in the most important areas, such as medical research, and, in doing so, open up new partnerships with universities outside of the EU.
Removing burdensome regulations
The second benefit of leaving the EU for science is the removal of existing EU regulations that hurt scientists and restrict innovation and, equally important, our protection against similar future errors by EU regulators.
This risk is demonstrated by the EU’s disastrous clinical trials directive, which brought added complexity and bureaucracy and laboratory facility requirements to conducting medical trials. The number of non-commercial trials in the UK fell from more than 600 in 2000–2003 to fewer than 300 in 2004–2007. Morris Brown, professor of pharmacology at the University of Cambridge, called this a “threat to patients’ lives” while Rory Collins, head of the Nuffield Department of Population Health and professor of medicine and epidemiology at the British Heart Foundation, stated it was “killing people”. Such was the exodus of trials and talent to the United States, one American administrator is said to have called it “Europe’s gift to America”.
The core of the problem with the EU — its propensity to be lobbied by big corporate vested interests and then legislate clumsily on their behalf — was summed up by the Eurordis patients’ group, which said: “The costs involved in initiating a trial in Europe will be only affordable to big pharmaceutical companies and keep out academic research and small and medium-sized enterprises.” Despite this barrage of criticism, the EU took more than ten years to cobble together a still problematic correction.
These specific errors are compounded by the flawed and misused precautionary principle, which places a political proclamation over the net benefit judgement of pharmaceutical researchers and medical professionals. Moreover, the decision to continue to subsidise tobacco while regulating biotechnology so clumsily has led to a leading European firm leaving the EU for the United States, demonstrates that the EU regulates according to lobbying and political whim as opposed to scientific principle.
The greatest risk for science is for the UK to stay in the EU and be at the whim of its inept regulators. The safer option is to leave and have scientists – not politicians and bureaucrats – in charge of agreeing new regulations that suit all of our international partners, boosting international science cooperation outside the EU.
The final benefit to leaving the EU is financial. Leaving would mean no reduction in EU funding, but would save our £9bn–£13bn per year net and £19bn gross contribution, depending on how much wider EU spending is kept on. The Leave campaign has repeatedly committed to spending this money on the NHS (particularly the drugs fund) and scientific research. If the public votes to leave, they will have sent a clear message that they expect the dividend from doing so to go towards higher funding for science, especially those working with the NHS.
The greatest risk to the NHS, pharmaceutical industry and British science is to remain in the EU at the whim of its regulators and worsening institutions, waiting for the next clinical trials directive type mistake to occur and take ten years to be corrected. Outside the EU, the UK will be able to have an immigration policy, regulations, institutions and funding that attract the most innovative scientists and science to this country. We can then focus on what should be our national mission: being the world’s leading country for science and innovation.
Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2016.20201011
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