Beyond Brexit: How to keep pan-European health partnerships intact

There is a need to look beyond the continuing uncertainty of the UK’s departure from the EU, find ways to avoid key health and research partnerships falling to pieces and devise a plan for how the UK and the rest of the continent will work together in this critical area in the long run.

“Basically, the key is to build things that go beyond the politics,” said Pierre Meulien, executive director of the EU’s pharmaceutical research project, the Innovative Medicines Initiative, speaking at a recent Science|Business meeting in Brussels.

“The trend is not isolation but the collective,” said Meulien. “The trend is about extending partnerships beyond European borders. Anything that perturbs that momentum and trajectory is lose-lose for everyone.”

The how and when of leaving the EU continues to defy easy prediction, but it is having a clarifying effect in some respects. The importance of collaborations “is elevated”, said Marja Makarow, director of Biocentre Finland and chair of Technology Academy Finland.

No one will be untouched by Brexit. “It’s not only UK that will lose. The whole system will lose,” said Makarow. “No money can compensate for the loss of international networks. And the UK is the most mature research system we have in Europe; we have learned so much from them.”

But beyond the Brexit risks and shocks lies at least some opportunity for new relationships that could strengthen both the UK and Europe.   

“Health will remain the poster boy for collaboration, regardless of what happens with Brexit,” said John-Arne Røttingen, CEO of the Research Council of Norway. “Arguably life sciences should be the industry least hit because there are global platforms for cooperation beyond Brexit.”

These include the European Molecular Biology Laboratory, where collaboration “will prevail irrespective of Brexit,” said Makarow. The same applies for research at the European Bioinformatics Institute in Cambridge, she added.

Similarly, the European Joint Programme on Rare Diseases, which has the goal of developing 1,000 new therapies within the next eight years, is another project that counts several non-EU countries among its ranks.

“We only started this year but we’re already 35 countries from Europe and beyond,” said Daria Julkowska, scientific coordinator of the project. “We managed to bring the UK on board too; we found a mechanism that safeguards our collaboration.” The project allows for the participation of institutions in Leicester, Liverpool and Newcastle.

There is a feeling strong among science and industry circles that the UK should maintain the same level of collaboration post-Brexit, said Steve Bates, CEO of the UK BioIndustry Association. “We see the world globally. We can see how fast the US hubs are growing. You see the rise of China and other parts of the world. We shouldn’t make Brexit a self-fulfilling prophecy,” he said.

Bates hopes the new European Commission under Ursula von der Leyen, which comes into office on December 1, “Looks seriously at the task of helping people in the UK who are making the case for deeper cooperation. When we are at our best, we have a common purpose on a number of important issues,” he said.

As an example of this cooperation, Bates points to efforts around drug safety, which he says “has largely put an end to big health scandals” in Europe.

Re-selling research to the UK

For many of the larger businesses in the UK, it’s as if Brexit has already happened. Car manufacturers, for example, have moved production overseas, or put UK investment plans on ice.

Of any sector, pharmaceuticals has seen the biggest impact. Under an edict from the European Commission, marketing licenses of drugs centrally approved by the European Medicines Agency (EMA) have had to be moved from the UK to EU-27 countries, along with all quality assurance laboratories. Experts in drugs regulation at the UK’s Medicines and Healthcare products Agency have been cut out of EMA’s drug approval and oversight processes, putting 30 per cent of Europe’s top regulators on the bench.   

Scientists are desperately trying to avoid the same fate for their projects. “We can only plead for keeping our collaboration alive,” said Jean-Claude Dujardin, head of the department of biomedical sciences at the Institute of Tropical Medicine in Antwerp.

Advances on tropical diseases, which affect more than a billion people in the world's poorest countries, can’t happen without the deep pool of expertise in UK, said Dujardin. “There are only five institutes in Europe that work on tropical diseases such as dengue and sleeping sickness,” he said – one each in Switzerland, Germany and Belgium, and two in the UK.

Health is an area in which the need for continued cooperation is self-evident, said Jan Palmowski, secretary general of the Guild of European Research-intensive Universities, an association of 19 universities. “Health is in fact a particularly good area to make the case for working more with Europe because we share similar norms – around patient data privacy, for instance – that we don’t necessarily share with Asia or the US,” he said.

Jan-Philipp Beck, CEO of EIT Health, a network of health innovators and universities across Europe run under the auspices of the European Institute of Technology and Innovation in Budapest, talked about “re-selling” the EU to the UK. “We said very clearly and very early to our collaborators following Brexit, don’t stop working with the UK. The UK is Europe’s main bridgehead market for the US; it’s very important when we’re talking about access,” Beck said.

A messy, no-deal exit from the EU “would see us all lose,” Beck added.

“Every single group is now saying a no-deal Brexit would be damaging beyond belief,” said Barbara Wilson MEP, the UK’s Liberal Democratic party, which is campaigning for a delay to Brexit and a second referendum. Wilson’s preference is to call the whole thing off. “Brexit is not inevitable and certainly a no-deal Brexit is not inevitable,” she said.

Searching for a signal

Some around the table warned that the hardline position Brussels has held during Brexit negotiations is putting cooperation in public health and research at risk.

The commission-enforced relocation of the EMA from London to Amsterdam was an early marker of this.

Some at the table called the move rash, and characteristic of the relative inflexibility of the EU’s stance. The relocation of EMA and putting UK regulators on the bench is “regrettable,” Bates said.

He is relieved however, that there is a commitment to ensuring there will be some form of continued cooperation between the UK’s Medicines and Healthcare products Agency and EMA post-Brexit.

Others decried a narrow focus on regulating Brexit, over finding ideas for maintaining things that already work well.

“The European Commission has entered into preparedness for a no-deal Brexit. That means that they are really focusing on regulating Brexit rather than being open to new suggestions for finding a solution,” said Anca Miclea, senior expert on research collaboration grants at Erasmus University, Rotterdam.

David Boyd, director of UK corporate government affairs at the pharmaceuticals company AstraZeneca, said Europe is a “great place to invest in science.” However, many of AstraZeneca’s non-R&D investments are on ice pending clarity on Brexit. “Would we like to invest more into Europe? I can’t tell you until we know what’s going to happen with Brexit,” Boyd said.  

‘Get Brexit done’ is the mantra of the UK’s ruling Conservative party, but if there is an agreement on the terms, that would only be the beginning of talks over the UK’s future relationship with the EU.

The UK will have to separately negotiate its way into the 2021 - 2027 Horizon Europe research programme, agree the terms on which it is engaged with the EMA, and whether or not it has access to critical public health databases such as Eudravigilance, the pan-European system for recording adverse reactions to drugs.

Some positive signals from the EU about the need to safeguard research partnerships, “would make a big difference” for researchers, said Beth Thompson, head of UK and EU policy with the research charity Wellcome Trust.

Joanna Dupont-Inglis, secretary general of EuropaBio, the pan-European biotech trade body, suggested there should be a fresh EU life sciences strategy that “clearly makes the point that we need the UK”.

And with emotions running very high, everyone should probably take a breath, says Meulien. “The mood is going to dictate a lot of what can be done and what can’t be done,” he said.