Community Pharmacy

Pharmacists and students braced for impact of a no-deal Brexit

Taoiseach Leo Varadkar has warned that the government has “a concern around medicines”, saying that the State will stockpile supplies, including blood, over the coming months. This is in response to increasing concerns that Britain and the EU will not reach a deal on Britain’s exit from the EU.

Medicines currently pass relatively freely across European borders thanks to the mutual recognition agreement, a system whereby member states accept medical products, through an abridged process, that have been authorised in another EU state. Currently six out of every ten medicines used here either originates, is packaged, or passes through the UK before reaching Ireland. Despite the fact that Ireland will remain in the EU after Britain exits the bloc, if no deal is reached, there are fears medicine supplies could dwindle rapidly.

Concerned

Irish pharmacists are growing increasingly concerned about the supply of drugs in the context of Brexit, given that medicine shortages are already a challenge, with some important drugs being supplied on an allocation basis as it is.

Ann-Marie Horan, pharmacist and pharmacy owner, met with Irish Pharmacy News at her premises, the Fortfield Pharmacy, in Dublin’s Terenure. Unless a comprehensive agreement is reached, Horan believes that Irish pharmacists could suddenly find themselves in a situation whereby medicines they have been reaching for years are suddenly not authorised for use on the Irish market.

Horan is concerned that medicine shortages will worsen in the event of a no-deal Brexit. “There are products that go short every month. I have three patients who are on chemotherapy at the moment so every month I have to ring up and ask if I can increase my allocation [of certain drugs]. Products are already tightly controlled and can be difficult to get. In the event of a hard Brexit we could find ourselves in a very scary place and the HPRA will have a lot of important decisions to make.”

Uncertainty

Horan uses the very bad snow we experienced earlier this year to demonstrate how quickly the effects of a no-deal Brexit will be felt by Irish pharmacists and their patients. “It will happen very quickly – we get two deliveries of drugs every day here. Wholesalers only keep a few days of drugs in stock. During the snow, we waited weeks for some medicines to get back to good supply levels. They were held up at ports but it was manageable because small amounts were getting through. To help us manage the stock ourselves we dispensed a weekly instead of a monthly supply in some cases. If a hard Brexit were to happen, you would notice [shortages] very quickly.”

Horan believes that the uncertainty around what is going to happen is not helping matters. “It’s a hard situation because we don’t actually know yet if we are dealing with a hard Brexit and that makes it even more difficult to plan. If there was a hard Brexit, companies would have to re-test their products in an EU or Customs Union country. In reality that means they would have to comply with two different sets of regulations.

“If these regulations could be aligned and an agreement was reached that these products that we have been using for years don’t have to be retested then that would solve everything, but the problem is the uncertainty. Moving your testing operations abroad is an expensive process and for companies who just don’t know yet what will happen in terms of Brexit, they aren’t likely to start spending that kind of money. A lot of drugs  are going to be affected.”

Students and research

Irish Pharmacy News reached out to the School of Chemical Sciences in Dublin City University for their view on how Brexit will impact research and student output. Dr. John F. Gallagher is the Chair of the Chemical & Pharmaceutical Sciences degree and lectures in Inorganic Chemistry. Gallagher shares that the academy is already seeing evidence of the effects of Brexit, as there has been a noted increase in the numbers of visiting research students from non-EU origin, such as Brazil, Malaysia, Korea and Japan, among other nations, as students seek to conduct research in an English language working environment. Gallagher also predicts that there will be increased research opportunities with partners in France, Germany, Spain and Italy as UK participation rates decline significantly.

“The education and training of University students and especially postgraduate students at the Masters and PhD level can and will adjust to the impact of Brexit. However, given the on-going decrease in funding for third level research and training, it is important to realise that the ability to respond quickly to changes due to Brexit may be somewhat compromised unless we start reviewing the (bio)pharmaceutical sector in its entirety from undergraduate degree programmes, through postgraduate research and training through to employment.”

Gallagher tells IPN that the UK is a major centre for (bio) pharmaceutical research and development and “ranks with Germany and France in terms of major contributions to the EU research and development budget.” These three nations provide approximately 60% of annual research funding and the UK currently benefits from this arrangement as skilled researchers pass unimpeded through its borders. They also benefit from funding pools that can be put towards both academic and industrial research. Gallagher says that a consequence of a drop in research funding will be that the remaining countries (including Ireland) “may be asked to stump up more research money with resulting political ramifications”.

Universities are also concerned about “the possibility of slower access to and delays obtaining laboratory (bio)chemicals should the logistics and supply chains get disrupted in the aftermath of a no-deal Brexit. This would have an impact on (bio) chemicals, radionuclides with a short half life as well as cost implications in respect of VAT and customs duty. Substantial delays will mean price increases and hamper research relying on sensitive (bio)chemicals. In terms of equipment purchases and servicing, the cost of maintenance and repairs will increase as many global manufacturers have European sites located in the UK. We can expect a substantial increase of costs in this regard.”

No guarantee

Back in Terenure, Ann-Marie Horan expresses concern for students who are currently studying in the UK. “Traditionally a lot of Irish pharmacy students would have studied in England and the ones who are there at the moment are in limbo. What will their position be when they come back here? At the moment both countries acknowledge each other’s accreditation. In the event of a hard Brexit there is a big question mark over whether or not that situation will remain in place. There are many people now studying in the UK who went there with the intention of coming back to Ireland with their qualification to work, but there is no guarantee at the moment that this situation will continue. I would imagine that this is causing students and their families a lot of stress at the moment.”

Horan wants the political powers to have consideration “for the health of all of the populations” and doesn’t believe that the headlines around stockpiling are going to solve anything. Medicines are not kept in huge quantities by wholesalers and if Britain crashes out without reaching a deal, the mutual recognition arrangement will very suddenly cease to operate, meaning medicines that have been safely used here for years will suddenly not be authorised for use in the Irish market.

“There are so many niche drugs that people are on and there isn’t a huge volume of them to hand, but to that one individual who does depend on it, it’s very important, so I just don’t see that these types of drugs will be stockpiled. In every pharmacy in the country there is one person on an unusual drug that is very important to the life of that person. We just want a smooth transition but the Brexiteers don’t seem to care about the economic or the social consequences. They aren’t really listening to arguments like that.”

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