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- Theresa May this week confirmed the UK will leave Euratom as it leaves the European Union.
- The Euratom treaty allows cancer treating isotopes to be imported to the UK quickly.
- Leading medics and charities tell BI the UK government is not doing enough to prepare for leaving Euratom.
- Increased customs checks are "going to put patients at risk," BI is told.
- DExEU dismisses concerns as "scaremongering."
LONDON — There is a growing concern among British medical specialists that leaving the European Union threatens the supply of cancer treatment.
Medical experts and charities have told Business Insider that Theresa May's plan to leave Euratom — the EU's atomic energy agency – will disrupt the inward flow of isotopes used for cancer treatment and put thousands of patients "at risk" of delays to treatment.
Nuclear material used in cancer treatments rapidly loses its radioactivity and cannot be stockpiled. Experts therefore believe that the prime minister's plan to leave Euratom and increase border checks with the EU carries a real risk to patients.
"Fracturing our relationship with Europe is not a good thing for patients, research or the supply of materials," Professor Michael Rees of the British Medical Association told BI this week.
"Any barriers to anything which is urgently required in healthcare is going to put patients at risk."
The prime minister confirmed earlier this week that the UK would cease to be a member of Euratom after Brexit.
"Membership of Euratom is an integral part of membership of the European Union. We are coming out of Euratom as we are coming out of the EU," May said in response to a question from Layla Moran, Liberal Democrat MP.
The government has reassured the medical community that leaving Euratom will not put an end to close ties with the treaty. In a technical note published on Tuesday, it said it wants to remain "as close as possible" to Euratom, and is seeking a "regime that provides coverage and effectiveness equivalent to existing Euratom arrangements."
However, leading medics and charities are concerned that the government will fall short of replicating the benefits of Euratom membership, and as a result, put new, potentially-dangerous pressures on cancer treatment.
"I gathered in Mrs May’s speech that she wants to participate in agencies covering drugs and medical devices, but she didn’t mention Euratom," Professor Rees told BI.
"I was very disappointed and I continue to be disappointed that we seem to be wanting to go down the route of leaving Euratom, and not developing as close a relationship as we possibly can."
What is Euratom?
Euratom is a treaty for nuclear regulation which oversees the speedy, smooth and safe movement of nuclear materials between European states. The nuclear material moved to and from countries mainly takes the form of fuel for power stations, and radioactive isotopes, which are used to perform cancer treatment and diagnosis.
Up to 80% of radioactive isotopes used in UK hospitals are imported, the Financial Times reported last year. The vast majority of these isotopes are imported from EU member states, "largely from the Netherlands, France and Belgium," the BMA stated in its October briefing on Brexit and Euratom. NHS England data shows that these isotopes are used to perform over half a million diagnostic scans every year.
Any barriers to anything which is urgently required in healthcare is going to put patients at risk.
And while isotopes can be imported from outside the EU, Britain's reliance on products from within the bloc means failure to either remain inside Euratom after Brexit, or at least be closely wedded to it, will "result in the isotopes not reaching the patients in time or reaching them with a low level of activity," Professor Rees told BI.
He added: "You can get supplies from outside of Europe but transport delays mean they would be less effective. You can get isotopes from South Africa, but they are 20% less effective. 20% less effective means 20% more expensive."
The isotope most commonly used in diagnosis is molybdenum-99. This isotope loses half of its radioactivity every 66 hours, meaning it must be moved as quickly as possible in order to be effective. "As isotopes have a short half-life and cannot be stock piled, continuous and timely access is vital for patient safety," the BMA said in October.
Professor Rees said that in an ideal world, the UK would remain both in Euratom and the customs union, in order to maintain the prompt and frictionless inward flow of isotopes from the EU. Isotopes reach the UK by road and increased customs checks on the borders would significantly slow down the transportation process.
The BMA has warned that increased customs checks pose a grave threat to the "consistent and timely access to radioactive isotopes," potentially causing "delays in diagnosis and cancelled operations for patients."
YouTube/Ian Murray MP
Labour MP Ian Murray, who has been in dialogue with cancer charities throughout the Brexit process, told BI there is growing alarm among charities over the apparent lack of government preparation for increased customs checks on isotopes coming into the country.
"There are no transitional or emergency plans being put in place by the government on what happens if we fall out of the EU without a deal or there are changes to customs at the borders," Murray, a supporter of the Open Britain group, told BI.
"A 30-second delay per movement would create 17 miles of tailbacks at the border. None of that has been thought through. Isotopes would be part of that process and even more complicated given the sort of material it is."
Josh Buscombe, president-elect of the British Nuclear Medicine Society, warned last November that the government had provided no answers on post-Brexit arrangements.
"We need more detail than just being told it will not be a problem," Buscombe told a House of Lords committee.
Moran, MP for Oxford West and Abingdon, who quizzed the prime minister about Euratom in the House of Commons this week, accused the government of being "in denial" about the real implications of leaving Euratom.
"They persistently accuse industry and MPs of scaremongering and then bat the issue away,"
"They persistently accuse industry and MPs of scaremongering and then bat the issue away"
Moran, a member of anti-Brexit group Best for Britain, told BI.
"The government desperately needs to listen to the concerns on industry or patients will suffer. Perhaps now that Theresa May has conceded some role for the ECJ this should unlock a more common sense approach."
A spokesperson for Department for Exiting the European Union described concern over the UK's relationship with Euratom after Brexit as"scaremongering," in a written statement sent to BI.
They said: "As we have said previously: While medical isotopes are covered by the Euratom Treaty, Euratom places no restriction on their export outside the EU. The UK’s ability to import medical isotopes from Europe and the rest of the world will not be affected by withdrawal from Euratom.
"As the Prime Minister has said, we are committed to a far-reaching science and innovation pact with the EU which would enable the UK to engage in key programmes with our EU partners."
Professor Rees was hopeful that political will on both sides will lead to an arrangement which comes close to replicating Euratom. However, even in this scenario, the industry would be left frustrated, he said, because an "awful amount of time, energy and money" would be spent on "trying to duplicate something which already exists."
Regulatory divergence would "halt" vital research
Christopher Furlong/Getty ImagesThe CEOs of several cancer charities will next week make a direct appeal to government ministers to ensure cancer treatment is prioritised in the second phase of Brexit negotiations with the EU.
Charities welcome May's commitment to exploring how the UK can stay in EU agencies like the European Medicines Agency but want her to go further to retain prompt access to cancer treatments and drug development schemes.
One of the CEOs is Sarah Lindsell of The Brain Tumour Charity. Lindsell is worried that regulatory divergence, as advocated by the Cabinet's chief Brexiteers, would cut the UK from vital supplies and research.
Brexit must not halt the vital progress we are making.
A particular area of concern for The Brain Tumour Charity is on cross-border clinical trials. In many rare and childhood cancers, patient populations are too small to conduct clinical trials solely in the UK, so cross-border trials are carried out under the EU's Clinical Trials Directive, in order to maximise the patient population. This vital practice of trialling cancer treatment hinges on close regulatory alignment between member states.
"Cross-border cooperation is absolutely crucial to our vision to defeat brain tumours – the biggest cancer killer of children and adults under 40 in the UK," Lindsell told BI.
79% of the charity's research funding in 2016/17 was directed to projects involving global collaboration, as opposed to collaboration solely between UK partners. The Brain Tumour Charity fears divergence from EU regulations after Brexit would undermine cross-border clinical trials for some of the deadliest diseases affecting Brits.
An example Lindsell gave was BIOMEDE, a pan-EU clinical trial currently being conducted for Diffuse Intrinsic Pontine Glioma, an aggressive childhood brain tumour, for which there is no effective treatment currently available on the NHS.
"This is why we want to see the Government negotiate an arrangement of regulatory alignment with the EMA and EU clinical trials regulation to ensure that vital research can continue," Lindsell said.
"A cure can’t wait for those diagnosed with a brain tumour, and Brexit must not halt the vital progress we are making."
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