With impending withdrawal from the European Union (EU) just over a month and a half away, senior clinicians and commissioning officers from the NHS and the royal college of physicians have expressed concerns over the import, tariffs and supply of pharmaceutical drugs manufactured or supplied from within the EU. Current supplies and shortages for certain medicines are of concern surrounding medicines which require refrigeration or specific preparation and storage such as insulin and certain types of novel drugs. In December 2018, 87 drugs were reported to the pharmaceutical services negotiating commissioning committee as in shortage, sparking a debate between suppliers, doctors and pharmacists on stockpiling of drugs and medicines.
A major concern for patients and doctors is the 20% of all prescriptions which are comprised as branded drugs; often niche compounds which are designed by pharmaceutical companies to fill a void in a treatment strategy and are under patent for a long period of time before other companies are permitted to manufacture the drugs. Medicines like paracetamol and ibuprofen have been generically manufactured for many years, leading to a reduction in their price and availability, yet patients who are receiving niche and novel treatment with breakthrough drugs may be affected through shortages if their manufacturer produces the drug inside the European Union.
Even in cases where generic drugs are manufactured in the UK (GlaxoSmithKline, Pfizer), the raw materials which are involved in the chemical process often come from industrial exporters such as China and India. The expected delays in port trafficking and cargo sorting at the British ports may potentially slow down the delivery of expected cargo if it has travelled through mainland Europe by lorry, causing delays in supply chains for generic medicines. Any medicine cargo which has shipped directly from those countries will likely be on time, according to the British Generic Manufacturer’s Association.
The secretary of state for health and social care wrote to the NHS and government advising against excess ordering and stockpiling independently due to government preparations; ‘Clinicians should advise patients that the Government has plans in place to ensure a continued supply of medicines to patients from the moment we leave the EU. Patients will not need to and should not seek to store additional medicines at home.’ Most of these concerns are voiced over the prospect of a no-deal Brexit, which may see no negotiation on the European medicine commissioning for drugs. However, the scale and prospect of humanitarian crises shall surely be avoided due to the long-term preparedness of the government and NHS yet concerns remain high for perishables and diabetic treatments.
A prospective method debated by the government currently is the assignment of medicinal shipping cargo to other ports in the United Kingdom aside from Dover, one of the largest shipping lanes in the world. Other ports potentially implicated in the plan include Poole, Portsmouth, Southampton and Felixstowe which have proximity to nearby motorways – and ports such as Felixstowe could be particularly important in Insulin delivery from Scandinavian manufacturers. Despite all the preparations in place, patients have been stockpiling medicine and supplies in the event of a tumultuous withdrawal, which at the time of writing is in prospect of being pushed back to beyond the 29th March.
The withdrawal of the UK from the EU, and the impact on chemical, pharmaceutical and medical supplies remains to be seen, but exists as an ominous reminder of the complexity and fluidity required in maintaining a basic healthcare system.