Five issues facing health policy in the Brexit debate

The big political issues are making the headlines, but how would a British departure from the European Union affect the nuts and bolts of European cooperation?

Burson-Marsteller Brussels hosted a panel discussion on ‘Brexit? The impact on Health Policy and Pharmaceuticals’ last week, with Brussels’ most influential health policy thinkers in attendance.

Here are the five key issues facing EU health policy as the British referendum and a potential Brexit looms.

1. ‘Regulatory disentanglement’ – a complicated term for a complicated process

The European Medicines Agency (EMA) is the hub of EU pharmaceuticals regulation – and it is based in London.

Were the UK to leave the EU’s medicines regulation structure completely, there would clearly be a question mark over whether centralised marketing authorisations would still apply in a post-Brexit UK.

For the rest of the EU, the question mark would hang over ongoing market authorisations. What would happen to marketing authorisations during the Brexit process – and would we see a period of delay in which new authorisations are put on hold?

For Britain, there is another consideration: the threat of losing many London-based highly-skilled jobs in regulatory affairs may mean that the UK tries (at least in the area of pharmaceuticals) to retain membership of the European Economic Area and so be part of the European pharma regulation structure.

2. Going it alone?

The UK would face a huge administrative undertaking to establish a separate regulatory system for pharmaceutical safety, and it is far more likely that the UK would stay close to the EU on such matters.

Switzerland presents an interesting case, however: it has a world-class pharmaceutical industry, but is outside of the EU/EEA and most regulatory cooperation. Is this success based on the financial incentives of being based in Switzerland? Would the UK have to go down a similar road to attract investment?

The Swiss recently suffered a cut to EU R&D funding (under the Horizon 2020 programme) when it voted to end free movement of people from the EU. EEA membership would probably require adherence to the EU’s free movement principles – something that may be unpalatable given that migration is likely to be a key motivating factor for pro-Brexit voters.

A Swiss-style Horizon 2020 funding cut could see a flight of academics from the UK to countries that would have easier access to collaborative international research projects.

3. Does ‘the sick man of Europe’ actually set a good example?

EU public health policy may, perhaps counter-intuitively, be weakened by UK exit.

The UK is not known as one of the healthier European countries, but it drives many policies aimed at improving health (even though these policies are often frustrated by internal market rules): reform of the common agricultural policy, with subsidies for healthier foods, and not sugar or tobacco; traffic-light food labelling; minimum unit pricing for alcohol, notably in Scotland.

Likewise, on plain-packing for cigarettes, the UK wishes to go further than the rest of the EU. Will a Britain-less EU miss the UK’s progressive health policy stance?

4. The pharmaceutical industry and the referendum

The UK business environment for pharmaceuticals has a fine balance of pros and cons. The UK is a large market with a competitive corporate tax rate and good universities. The government has a clear commitment to life sciences, with a dedicated minister and government strategy for the sector.

But the National Health Service is slow to adopt innovation. Late stage clinical trials are difficult to conduct in the NHS, and pricing and reimbursement negotiations can be tough.

At our event, it was argued that an EU exit would tip the scale against investment in the UK: certainty of trade conditions is a vital factor in determining investment decisions.

5. Can the pharma industry support a ‘Yes’ campaign?

Given the sensitivity of the topic, it is hard to see drugs companies backing a ‘Yes’ campaign any time soon.

Many CEOs wish to play David Cameron’s game, and hang back from supporting membership until the Prime Minister presents his proposals for ‘renegotiation’ – effectively endorsing Cameron’s approach of supporting membership, but not at all costs. The industry also believes more competitive advantages might be sought by taking a tough stance.

Nevertheless, many fear Brexit and want to do something sooner, helping to shape the debate around cold, hard facts (although there is much doubt as to whether voting in the referendum will be based on such rational calculations).

A majority of people at our event thought that Brexit would be negative for both UK and EU health policy, but most believed that full exit would be so complicated that the UK would retain EEA membership at the very least.

At the same time, a majority in the room believed that all these rational calculations made on pros and cons are unlikely to play a strong role in deciding the outcome of the referendum. It is still likely that fears about migration and views of the government will decide the outcome.

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Words  Sam Kynman
Photo  Wikimedia Commons – Intel Free Press

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