Health secretary: UK to deploy planes to cope with Brexit medicines disruption

Government also considering fast-tracking trucks carrying medicines through Dover.

U.K. Health Secretary Matt Hancock said Friday the government is drawing up plans to use airplanes and fast-track trucks at the border to ensure the supply of medicines is not interrupted in the event of a no-deal Brexit.

“We are working on ensuring that we have aviation capacity,” Hancock told the BBC on Friday. “If there is a serious disruption at the border we will have prioritization and prioritization will include medicines and medical devices.”

As part of its preparations for a no-deal Brexit, the government is also looking into fast-tracking trucks carrying medicines through Dover if “there’s a serious disruption at the border” and increasing refrigeration units for medicines that can be stockpiled, the health minister said.

Hancock also said pharmacies in the U.K. may be allowed to issue small quantities of medicines without the approval of general practitioners if there are “serious shortages” as a result of a no-deal Brexit.

The Times reported Friday that ministers would be able to tell pharmacists to alter medications and dispense a “reduced quantity” of medicines without contacting GPs first.

National Health Service providers, pharmaceutical companies and patient groups warned last month that the government’s plans for maintaining drug supplies in the event of no deal were so lacking that the warning level should be raised to “red.”

“If there’s a shortage of an individual drug and pharmacists can make clinical and professional judgments, then that will be a step forward,” Hancock said.

The U.K. government is currently consulting on the idea and will ensure that it has contingency plans in place before the country leaves the European Union in March 2019, Hancock said.

“In the health department, we deal with contingencies all the time and this is an extension of that,” Hancock said.

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Growing pains: Europe’s push for medical cannabis

Big companies are making inroads into a potentially lucrative market, but legislators aren’t moving at the same speed.

Europe is coming around to medical cannabis — but many patients fear financial benefit will trump pain relief.

In November alone, the U.K. allowed doctors to write prescriptions for medicines containing cannabis; Greece granted its first two licenses to cultivate and process cannabis; and Luxembourg legalized cannabis for recreational purposes. Most EU countries currently allow some form of medical cannabis.

As patients push for access to these treatments, pharmaceutical companies and cannabis producers are hoping to claim a piece of a market that could be worth €55 billion by 2028, according to an industry report. The concern for many patients, however, is that legislators can’t (or won’t) keep up with demand, leaving medical cannabis to inch its way onto the market, product by product, country by country.

The European market is fragmented. Each country sets its own standards and regulations for cannabis products, meaning Germans can get a prescription for medical cannabis from a doctor, while the French have no legal medical cannabis options at all.

“Right now it’s like a jungle to navigate the European market,” said Thomas Skovlund Schnegelsberg, co-founder and CEO of Danish medical cannabis company StenoCare.

“They’re produced for people who want to get high on a Friday night” — Thomas Skovlund Schnegelsberg, co-founder and CEO of StenoCare

The European Union isn’t helping clear up the confusion. “We have a competence only to support the member states [on medical cannabis rules],” Peter Mihok from the European Commission’s migration and home affairs department told a European Parliament committee in June. “They are the ones that have to act first.”

But many countries aren’t acting, at least in part because legalizing medical cannabis is often confused with legalizing recreational marijuana. So when countries do allow medical cannabis, they often bring in strict rules. After the U.K. legalized medical cannabis last month, for example, it can only be given by prescription, from a specialist doctor and after other treatments have failed.

Such tight rules might work for those who want pills from a pharmacy, or cannabinoid (CBD) oil sold in shops, but it doesn’t help patients who want to grow cannabis at home, either for cost reasons or to give them more treatment options.

Patients’ push

Cannabis has become an increasingly popular treatment for patients with all kinds of diseases and conditions, including multiple sclerosis, epilepsy, anorexia, insomnia and cancer.

The cannabis sativa plant has more than 100 unique compounds known as cannabinoids, according to the European Monitoring Centre for Drugs and Drug Addiction. The most well-known of these is tetrahydrocannabinol (THC), which causes a euphoric high, although many people who use cannabis for medical purposes select cannabinoids with different effects, such as the invigorating sativa and relaxing indica.

Aerial view taken on September 19, 2018 shows farmers with their specially developed harvesting machines cropping a cannabis field in Naundorf, eastern Germany | Jan Woitas/AFP via Getty Images

Carola Pérez was taking 19 pills a day before she discovered medical cannabis. Pérez has suffered from chronic pain since she broke her tailbone at the age of 11. The childhood accident led to 13 surgeries and an addiction to the opiates she took for relief.

Pérez first tried THC-infused milk 10 years ago, before CBD oils were available. She felt relief almost instantly, and over time was able to reduce the 19 daily opiates she was taking to just two. “Cannabis saved my life,” she said.

The problem was how to get it.

Pérez is from Spain, where cannabis is permitted for personal use but there is no national regulation for how much one person can grow. The hazy law led to the creation of so-called cannabis social clubs — registered groups that grow cannabis largely for recreational use.

At first, Pérez asked a friend to get her the drugs she needed, then she used a street dealer. She tried the cannabis social clubs, but they didn’t have enough. That’s when she took things into her own hands.

Pérez now grows 16 strains of cannabis in her home. Depending on the day, she can create a cannabis cocktail with whatever levels of CBD, THC, sativa and indica she needs.

That gives her a freedom that isn’t available in the pharmacy. Sativex, a cannabis-based mouth spray costing over €400 a bottle and made by GW Pharmaceuticals, was approved for Spanish patients in 2010. But it can only be used by people with multiple sclerosis.

“No pharmaceutical company is going to be able to offer us that,” said Jacqueline Poitras, a medical cannabis activist in Greece whose 18-year-old daughter takes CBD oil for often-daily epileptic attacks. “Only nature can offer us that.”

Here comes big business 

Big companies — both pharma giants and cannabis producers — are lobbying lawmakers across Europe to put their products on the market now.

They argue that untested cannabis may contain harmful pesticides and that products sold on the black market are often created for recreational use and merely re-labeled as being for medical purposes. Patients using such products report psychosis and other unpleasant side-effects because “they are not made to be used for sick people,” said Schnegelsberg of StenoCare. “They’re produced for people who want to get high on a Friday night.”

Plants growing in a cannabis field in Naundorf, eastern Germany, on September 19, 2018 | Jan Woitas/AFP via Getty Images

But smaller cannabis producers are wary of the pharmaceutical companies’ push. The European Industrial Hemp Association said it “strongly opposed” attempts by big pharma to make CBD a prescription drug.

“This only serves the interests of a few companies while damaging the young CBD industry,” the association wrote in October.

Stephen Murphy, managing director of the international cannabis consulting company Prohibition Partners, said he saw a similar situation in the U.K. Once GW Pharmaceuticals was “in the driving seat” there was almost no national debate on the issue, he said.

“It took quite a big PR campaign this year to legalize cannabis for patients in the U.K. despite the fact that cannabis has been grown in the U.K.,” Murphy said. “There was never any pressure to challenge that.”

Patients also have concerns about how the big companies are attempting to enter the market. “These companies only call us … to say, ‘Oh poor patients,’ but then they don’t take care of us, don’t help us with our projects,” said Pérez. “They just call us to [be able to use us] to tell our stories and then continue with their business.”

The debate has reached the EU. In the summer, the European Parliament’s Environment, Public Health and Food Safety Committee called on the European Commission to create an EU-wide policy for medical cannabis. Not long after, big companies came calling to make their voices heard.

One was Canadian company Canopy Growth, one of the largest cannabis firms in the world and which recently invested €100 million to create more production facilities in Europe. Another was GW Pharmaceuticals.

Canopy Growth did not respond to a request for comment. GW Pharmaceuticals said it would not comment on individual meetings with MEPs, but it “has ongoing engagement with relevant stakeholders focused on education.” It said it has no stance on legalizing medical cannabis, but that with cannabis-derived medicines, “clinicians and patients can be sure of their quality, safety and efficacy — the same as for any other medicine.”

Debate in the parliamentary committee focused on whether the resolution should contain the term “medical cannabis” or “cannabis-based medicines.” That matters because the former would advocate for citizens to grow their own cannabis while the latter would be limited to over-the-counter medicines.

Some want the EU to create a set of guidelines for member countries to consult when they begin the process of legalizing medical cannabis | Leon Neal/AFP/Getty Images

The committee’s resolution passed last month with amendments, using the more narrow “cannabis-based medicines” language, much to the frustration of some Parliament officials.

“Of course, it’s understandable that companies that have undergone decades of research want some preference for their products, but a lot of research shows that herbal cannabis is important,” one parliamentary official said. “That experience should not be taken away from patients.”

The next step is a debate of all MEPs in Strasbourg.

Michael Barnes, a U.K.-based professor of neurology who worked with the U.K. government on changing its medical cannabis laws, said he’d “love to see some kind of standardization” across Europe.

So would many patients. Some want the EU to create a set of guidelines for member countries to consult when they begin the process of legalizing medical cannabis. Others want cannabis covered by the directive on medicinal herbal products. But mainly, they just want the EU to do something.

I think they could, but I don’t think they will,” said Sébastien Béguerie, a cannabis activist and founder of AlphaCAT labs, which tests the quality of cannabis. “It would open the gates too much … and legislators are afraid.”

For now, patients are fighting on the national level. Poitras is working with Greek officials to create a law that stops big, foreign cannabis companies buying up land to grow cannabis and export it.

“We’re pushing,” Poitras said, adding that in the meantime she’s encouraging patients who need medical cannabis to grow their own.

EU agency offers free holidays in Amsterdam to help sway staff move

European Medicines Agency’s Brexit point-man says staff retention is looking up.

LONDON — The European Medicines Agency is sending staff on holiday to the Netherlands to persuade them what a great place it will be to live.

The agency, which is relocating from London to Amsterdam in March because of Brexit, is covering the cost of a two-night trip for staff and their partners — plus a guided tour of neighborhoods — to help employees decide if they could plant roots there.

Noël Wathion, the EMA’s Brexit lead, said in an interview Wednesday that while he could not quantify the impact of the visits, the EMA believes they are proving “very useful” as it attempts to keep staff on board.

“It’s a short visit but nevertheless it shows you [what the Netherlands is like to live in],” Wathion said. The agency is also offering free Dutch language lessons for EMA staff, their partners and children.

The number of staff forecast to stay has been on an upward trend since providing these incentives, Wathion said.

Staff are not just moving to Amsterdam but all over the Netherlands, he said, including to Leiden, the Hague and Utrecht.

The latest estimates show 24 percent of the EMA’s roughly 900 staff — including shorter-term and longer-term contracts — are forecast to leave, although he said that figure changes daily.

That would leave around 216 vacant posts. Around 100 of these are people on short-term contracts, such as maternity cover, which would not relocate, he said. In August, a survey found 30 percent were expected to leave.

The agency has received more than 5,000 job applications for the vacancies, Wathion said. The agency is also putting together a reserve list of candidates who have passed interviews and would be willing to work in Amsterdam if certain jobs become available.

“We can’t wait and see,” Wathion said. The agency has asked staff to inform them as soon as possible if they plan to leave.

Relocation underway

Sixty staff have already moved to the Netherlands. The Spark building in Amsterdam will house the EMA from January until its permanent home, the newly named “EMA Building,” is ready in November.

These are primarily employees with children who wanted to move early for the start of a new school year, Wathion said.

These “early movers” are also influencing other staff members. “We have positive feedback and people say, ‘it seems to be working,’” he said.

Wathion said the bulk of staff are expected to relocate in January and February. However, the agency has also adapted its flexible working policies to allow people to move later during 2019, for example for parents of children that need to sit for school exams.

Staff are not just moving to Amsterdam but all over the Netherlands, he said, including to Leiden, the Hague and Utrecht.

Despite the sheer complexity of decoupling the U.K.’s expertise from the agency, sharing out its workload and relocating all operations, Wathion sounded more upbeat about the process than in previous interviews.

He said the agency has adopted a mantra for the relocation: “‘United we stand, divided we fall.’”

CORRECTION: A previous version of this story misstated the agency’s relocation mantra, and misstated when the EMA will be housed in the Spark building. 

Science minister quits over Brexit deal as UK ends Galileo talks

Negotiation ‘stacked against us from the very beginning,’ says Sam Gyimah.

U.K. Science Minister Sam Gyimah quit late Friday over Prime Minister Theresa May’s Brexit deal, after the government pulled out of “frustrating” talks on the EU’s Galileo satellite navigation system which offered “only a foretaste of things to come.”

Gyimah, who served in the Education Department and did not have Cabinet rank, is the seventh minister to quit since May presented the Brexit deal negotiated by the British government and the EU to Cabinet two weeks ago. He said he would vote against the agreement in the House of Commons.

The government on Friday abandoned efforts to remain within the satellite project and is likely to forego the £1.2 billion it has already invested in the scheme.

“After careful consideration and reflection, I cannot support the Government’s deal and as such, I have tended my resignation as Universities and Science Minister,” Gyimah, who voted Remain in the EU referendum, said in a Facebook post.

“The government is finally pulling out of frustrating negotiations over Galileo, the EU’s strategic Satellite Navigation system. The PM is right to call time on a negotiation that was stacked against us from the very beginning. But Galileo is only a foretaste of what’s to come under the Government’s Brexit deal,” he said.

“Having surrendered our voice, our vote and our veto, we will have to rely on the ‘best endeavours’ of the EU to strike a final agreement that works in our national interest. As Minister with the responsibility for space technology I have seen first-hand the EU stack the deck against us time and time again, even while the ink was drying on the transition deal,” Gyimah said.

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WHO chief: EU needs to boost HPV vaccine supply

European countries need to help increase supply of a vaccine to prevent cervical cancer, said the World Health Organization chief, especially as they plan to offer the shot to both boys and girls. WHO Director General Tedros Adhanom Ghebreyesus told POLITICO in an interview that gender-neutral vaccination against the human papillomavirus — which causes cervical […]

European countries need to help increase supply of a vaccine to prevent cervical cancer, said the World Health Organization chief, especially as they plan to offer the shot to both boys and girls.

WHO Director General Tedros Adhanom Ghebreyesus told POLITICO in an interview that gender-neutral vaccination against the human papillomavirus — which causes cervical as well as oral and throat cancers — is “important.”

“But the supply is short,” he continued. “There should be commitment to increase the supply and do it gender neutral.”

Tedros in May issued a call to action toward a goal of eliminating cervical cancer, which is highly treatable if caught early and can be prevented by HPV vaccination.

However, his position appears to differ slightly from that of his key advisers on the disease, who told POLITICO in October that wealthy countries’ moves to expand the HPV vaccine to boys could hurt the supply to immunize girls in lower-income countries.

“If globally we would like to make more progress, it would be better if the available vaccines at the moment would be used to vaccinate girls … until we have resolved the supply issue,” said Anshu Banerjee, WHO’s director of maternal, newborn, child and adolescent health.

WHO officials said it can take several years to boost manufacturing to respond to new demand for the vaccines.

Vaccinating at least 70 percent of adolescent girls is key for creating herd immunity. However, Germany, the U.K. and Ireland recently announced plans to expand the availability of the vaccine to boys, and the U.S. approved immunization for people up to the age of 45.

Countries taking this route should contribute money toward expanding supply, Tedros said, “but at the same time, domestic resources should be mobilized, and the pharmaceutical industry should be more help.”

Draft text aims for ‘ambitious, wide-ranging’ post-Brexit partnership

Political declaration document considered by EU27 ambassadors.

The U.K.’s future relationship with the EU post-Brexit will be an “ambitious, wide-ranging and balanced economic partnership,” according to a draft copy of the political declaration document seen by POLITICO that will accompany the Brexit divorce treaty.

European Council President Donald Tusk tweeted that the text had been “agreed at negotiators’ level and agreed in principle at political level, subject to the endorsement of the [EU] Leaders.”

The text has grown from a seven-page summary published last week alongside the 585-page draft Withdrawal Agreement, but negotiations on its content are expected to continue right up to the eve of an EU leaders summit on Sunday. After their meeting last night, the Theresa May said she would return Saturday for further talks with Commission President Jean-Claude Juncker.

Provisions in the political declaration include:

— A commitment on goods trade for the EU and U.K. to negotiate “a free trade area, combining deep regulatory and customs cooperation, underpinned by provisions ensuring a level playing field for open and fair competition.” That is a nod to the “near-frictionless” trade promised by May, but appears to fall short of her proposal for a common rule book that would mean the U.K. effectively remaining within the EU Single Market for goods.

— On the Northern Ireland backstop, the document says “The Parties recall their determination to replace the backstop solution on Northern Ireland by a subsequent agreement that establishes alternative arrangements for ensuring the absence of a hard border on the island of Ireland on a permanent footing.” That is likely designed to help Theresa May sell the deal to her MPs, many of whom are deeply unhappy about the backstop.

— A plan to “build and improve on the single customs territory provided for in the Withdrawal Agreement.” That will be controversial with U.K. Brexiteers because it suggests that customs arrangements included in the Northern Ireland backstop will form the basis for the future relationship — providing severe restrictions on any future trade deals. But, the draft agreement states that the future customs union will “build and improve on the single customs territory provided for in the Withdrawal Agreement which obviates the need for checks on rules of origin.”

— A commitment to “explore the possibility of cooperation of United Kingdom authorities with Union agencies such as the European Medicines Agency (EMA), the European Chemicals Agency (ECHA), and the European Aviation Safety Agency (EASA).” The EU has been resistant to the idea of associate membership for the U.K. of EU agencies. This looks like a softening of that line.

— On customs, the document says that “facilitative arrangements and technologies will also be considered in developing any alternative arrangements for ensuring the absence of a hard border on the island of Ireland on a permanent footing.” This leaves open the possibility of using new technology to prevent a hard border in Northern Ireland in future.

— On financial services, both parties pledge to begin proceedings to assess “equivalence” of each others rules immediately after Brexit day.

— On services, the EU and U.K. want to “conclude ambitious, comprehensive and balanced arrangements on trade in services and investment in services and non-services sectors, respecting each Party’s right to regulate.”

— On movement of people, there is a commitment to “establish mobility arrangements … based on non-discrimination between the Union’s Member States and full reciprocity.” These would allow visa-free travel or short-term visits and both sides “agree to consider conditions for entry and stay for purposes such as research, study, training and youth exchanges.”

— On fisheries, there is a no clear mention of an EU demand that access to EU markets for U.K. fishermen in a future trade deal should be contingent on access to U.K. waters. The text is pretty vague and says that “within the context of the overall economic partnership the Parties should establish a new fisheries agreement on, inter alia, access to waters and quota shares” adding that “the Parties will use their best endeavours to conclude and ratify their new fisheries agreement by 1 July 2020 in order for it to be in place in time to be used for determining fishing opportunities for the first year after the transition period.”

— On security, the document envisages a “broad, comprehensive and balanced security partnership” including data sharing of Passenger Name Record data and DNA, fingerprints and vehicle registration data for combatting crime.

— On data, the document envisages a deal by 2020: “In view of the importance of data flows and exchanges across the future relationship, the Parties are committed to ensuring a high level of personal data protection to facilitate such flows between them. The Union’s data protection rules provide for a framework allowing the European Commission to recognise a third country’s data protection standards as providing an adequate level of protection, thereby facilitating transfers of personal data to that third country.”

— On the European Investment Bank the two sides say they will “explore options for a future relationship with the European Investment Bank (EIB) Group.”

— The document does not mention Gibraltar.

EU health chief compares Brexiteers to Soviet plotters

Can you tell the difference between the European Research Group and the State Committee on the State of Emergency?

The European Commission’s health chief compared a hardline Brexit group to high-level Soviet officials who wanted to stop the reforms implemented by Russian leader Mikhail Gorbachev.

Vytenis Andriukaitis on Thursday tweeted a photo of the European Research Group at a meeting this week in which Jacob Rees-Mogg called on Tory MPs to force Theresa May from office next to a photo of the State Committee on the State of Emergency, a group of senior Soviet officials who launched a failed coup against Gorbachev in 1991.

Both photos are composed entirely of middle-aged white men in suits. “I’m not comparing anything,” said Andriukaitis, adding, “If i did, maybe I’d say a word on gender representation.”

The tweet appears to be a dig at the ERG’s failure, so far, to trigger a leadership contest in the Tory party. But it also revives a spat with U.K. Foreign Secretary Jeremy Hunt, who in September compared the EU to the Soviet Union during a speech at the Tory party conference.

Describing the EU’s approach to Brexit as an attempt to “keep the club together” by punishing “a member who leaves,” Hunt asked: “What happened to the confidence and ideals of the European dream? The EU was set up to protect freedom. It was the Soviet Union that stopped people leaving.”

“The lesson from history is clear: If you turn the EU club into a prison, the desire to get out won’t diminish. It will grow and we won’t be the only prisoner that will want to escape.”

That went down badly in the EU and especially with Andriukaitis, a Lithuanian who is European commissioner for health and food safety. He had a personal response for Hunt. “I was born in Soviet gulag and been imprisoned by KGB a few times in my life. Happy to brief you on the main differences between #EU and Soviet Union. And also why we escaped the #USSR. Anytime. Whatever helps,” he tweeted.

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Stephen Barclay appointed new UK Brexit secretary

He replaces Dominic Raab, who quit Thursday.

LONDON — Stephen Barclay has been appointed Brexit secretary, the U.K. government announced Friday.

The former health minister replaces Dominic Raab, who quit Thursday in opposition to Theresa May’s draft Brexit deal.

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Superbug risks fail to dent attitudes to antibiotics

Antimicrobial-resistant infections could be killing more than 33,000 people a year in Europe.

Warnings about drug-resistant superbugs aren’t enough to change most people’s behavior on using antibiotics, according to a Europe-wide poll out Thursday.

The Eurobarometer survey reported seven in 10 people who received information telling them not to take antibiotics unnecessarily said it didn’t change their views on using them.

Excess use of the drugs is contributing to a growing threat of antimicrobial resistance and related infections. As germs multiple they can develop the ability to defeat the medicines designed to kill them — and those infections could be killing more than 33,000 people a year in Europe, according to recent estimates.

“It is ridiculous,” European Health Commissioner Vytenis Andriukaitis said in response to the fact that people aren’t responding to warnings, at an event in Brussels Thursday. “We have science on one hand and lack of trust on the other.”

“Unless we act decisively, immediately and together, we could face a public health and financial disaster,” he added.

The EU is failing to gain traction with its effort to get member countries to combat the rise of resistance.

The Eurobarometer survey showed the number of people who had taken antibiotics in the last 12 months fell from 40 percent in 2009 to 32 percent in 2017. But less than half of people said they were aware that antibiotics don’t work to treat viruses, and 20 percent said they take antibiotics to treat flu or colds.

Seven percent of people said they took antibiotics without having seen a doctor or getting a prescription.

Andriukaitis said the survey, which polled around 27,400 people in 28 countries, shows Europeans “are still not sufficiently aware of the dangers of AMR.”

A report from the European Centre for Disease Prevention and Control (ECDC) on Thursday raised particular concern about the rise of superbugs in hospitals and care centers — estimating there are around 8.9 million cases of health care-associated infections in European facilities each year, many of them caused by multidrug-resistant bacteria.

Brussels is largely forced to take a backseat to national capitals | George Frey/Getty Images

The ECDC said these infections are being fueled in part by overprescribing of so-called broad-spectrum antibiotics, which wipe out multiple forms of bacteria and are stronger than traditional, more targeted antibiotics such as penicillin. Prophylactic antibiotics, meaning those prescribed before a surgery in anticipation of potential infection, are also being prescribed for too many days, it said.

Meanwhile the EU is failing to gain traction with its effort to get member countries to combat the rise of resistance.

The Commission released a One Health Action Plan in 2017 that included guidelines on how to ensure prudent use of antimicrobials in people, and promised to promote global standards in areas such as trade. It also set aside funding for research to monitor and control potentially fatal infections, and develop new antibiotics or vaccines to combat transmission.

But the EU’s limited competence in health means Brussels is largely forced to take a backseat to national capitals. While governments such as the U.K., Sweden and Finland have made fighting antimicrobial resistance a priority, Andriukaitis said Thursday he’s frustrated the EU can’t be more effective.

“Our main goal is to show that the EU is a best practice region fighting against AMR. But it will be empty words if you do not have concrete instruments at member states level,” he said.

Last line of defense

One area the Commission has been able to push new rules in on the use of antimicrobials in farm animals.

Andriukaitis said he is expecting a “major breakthrough in a few days” when the Council of the European Union will greenlight new rules on veterinary medicines and medicated feeds. These are designed to phase out the prophylactic use of antimicrobials as well as preventing their use to promote growth in cattle.

The EU will also under the new rules ringfence a protected list of antibiotics for human-use only — part of an attempt to keep drugs that still work in humans from becoming obsolete.

Malta and Croatia were named for their poor performances | Joe Raedle/Getty Images

The proposed list, a joint effort between the ECDC, the European Medicines Agency and the European Food Safety Authority, is expected to be put out for consultation next month, according to the ECDC.

ECDC Director Andrea Ammon said at the event Thursday that getting patients, health care providers and national governments to cut down on unnecessary prescribing will take time but there is still a chance to limit the threat from AMR.

The ECDC’s efforts to monitor antimicrobial resistance country-by-country in Europe have been “quite powerful because no one wants to be at the bottom” of the list, Ammon said. The agency also visits European countries at their request to assess their national antimicrobial resistance plans and recommend improvements.

Eight European countries saw a statistically significant drop in public consumption of antibiotics between 2013 and 2017, according to ECDC data released Thursday: Finland, Germany, Italy, Luxembourg, the Netherlands, Norway, Sweden and the U.K.

One area the Commission has been able to push new rules in on the use of antimicrobials in farm animals | AFP via Getty Images

Malta and Croatia were named for their poor performances, recording increases in antimicrobial consumption in hospitals.

A report on antibiotic use in humans by the World Health Organization published Monday concluded Greeks consume the most antibiotics on average in Europe, with Italy, France and Belgium also named as having high use.

Improvements are “not something that will happen very quickly because this epidemic has built up over years and it will take some years until it goes down. It needs sustained efforts,” Ammon said.

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Businesses call for state bailouts if UK crashes out of EU

Firms argue Brexit is a political crisis and no fault of theirs.

LONDON — A no-deal Brexit could require U.K. government bailouts like those following the financial crisis to prevent businesses from going bankrupt.

That’s the view of some in industry who see Brexit as a problem created by politicians that threatens to destroy British businesses and bring about an economic crisis.

Even if negotiators in Brussels craft a Brexit divorce deal in the coming days, it is far from certain that any agreement will be ratified by MPs in Westminster, and the U.K. could still leave with no deal at all, even though many among the country’s traders, manufacturers and in town halls say it is probably already too late to prepare adequately for it.

If the U.K. does fall over the Brexit cliff edge, ministers must leverage the government’s “financial muscle … in rather the way they did for the banks during the [2008] crash,” said Ian Wright, director general of the Food and Drink Federation, which represents 7,000 firms.

“If the government was to say no [to that] now there would be a very big question from British industry: ‘You were prepared to fund the banks who brought the crisis on themselves … but you’re not prepared to support British business which is completely innocent of any fault in the current circumstances?’”

Local councils have also expressed dismay at gaps in no-deal planning.

“Very few businesses in the U.K. asked for this to happen,” he added. “This is a crisis entirely created by politicians.”

While discussion of no-deal preparations has focused on what the government is doing — from re-engineering motorways to serve as lorry parks, to hiring more customs officers — industry and local government has also had a role to play.

They are closer to the day-to-day reality of U.K.-EU trade and their message is simple: At this late stage, there’s not much more that can be done to prevent major disruption.

In such a scenario some firms won’t survive, many predict.

Anti-Brexit demonstrators form a chain along Whitehall in London | Tolga Akmen/AFP via Getty Images

“If you’re an exporter and a significant proportion, say 30 percent or above, of your business is with the EU, or if you’re an importer and you have critical ingredients or products that you bring in from the EU — maybe you import feta cheese or salami — I think there’s probably relatively little you can do to be prepared for a no-deal Brexit. And for those businesses it’s perfectly possible that the disruption could be terminal,” said Wright.

A U.K. government spokesperson said in response: “It is in the interests of both the EU and the U.K. to strike a good deal and we are confident this will be achieved. But as a responsible government we are making plans for all possible outcomes, including the unlikely event that we reach March 2019 without an agreement.”

“This comprehensive no-deal preparation includes informing businesses through a series of technical notices what practical steps they need to take,” the spokesperson said.

Too late

When Whitehall published more than 100 “technical notices” over the summer giving advice to businesses, public authorities and citizens on what to do in the event of no-deal, the U.K.’s business lobby was unimpressed.

“We still don’t know exactly what no-deal would look like on the day it takes effect, whether the government would relax import controls or cut tariffs as a mitigating response,” said Allie Renison, head of Europe and trade policy at the Institute for Directors, which represents business leaders. “Even its own technical notices don’t suggest this, and much of the advice on import and export with EU has been fairly general.”

Only a third of the IoD’s more than 30,000 members have done contingency planning for a no-deal Brexit, Renison said.

Businesses using the ports could turn up the day after Brexit without the right paperwork or licenses.

Those that have not are often smaller firms that have struggled to afford the investment in staff, IT systems or outsourcing needed to ensure they are prepared for an EU third-country customs regime. With continuing uncertainty about whether there will or won’t be a deal, many have gambled on there being a deal rather than make an investment they can ill-afford.

“They can only prepare when they know the exact direction of travel,” said Renison. The IoD is also calling for financial support for business, in this case to assist with the cost of professional advice on no-deal planning. The Irish and Dutch governments have offered such schemes to businesses in their countries.

“As long as it remains government policy to potentially walk away, it is incumbent on them to make further provision to help firms be fully ready for the consequences of that outcome,” Renison said.

Local councils have also expressed dismay at gaps in no-deal planning. A report prepared for a meeting of the Local Government Association’s leadership board on October 17 said the government’s technical notices do not deliver essential practical guidance — or cash — for council-run port authorities that might be required to dramatically step up operations.

A lorry arrives at Dover Ferry Terminal on April 26, 2018 in Dover, England | Dan Kitwood/Getty Images

Pauline Bastidon, head of European policy at the Freight Transport Association, one of the U.K.’s biggest business groups, representing transporters, retailers and manufacturers, tells a similar story.

“Maybe three-quarters of the things that could have been done, if companies are waking up and deciding to do it now, it’s probably too late for March 2019,” she said.

At the moment U.K. government officials are considering waiving additional customs checks for all but security purposes in the event of no-deal. To alleviate snarl-ups at the ports of Dover and Holyhead, freight that needs thorough inspection will be sent inland to one of two clearing centers in southeast England at Milton Keynes or Heathrow. But there remains uncertainty at the very top of government about the stance French authorities on the other side of the Channel will take.

The problem is not just what the port authorities will do, but that businesses using the ports could turn up the day after Brexit without the right paperwork or licenses.

Concerns about food and medicine availability are well-documented.

“That’s quite probable,” said Bastidon, “certainly in the first few weeks. But should we really blame these companies? All these things come at a cost. When it comes to expenditure, companies have to ask: ‘Is it needed now?’ … The uncertainty around whether there is going to be a deal or not, all of this means that for industry it is a gamble [to spend on no-deal contingencies.]”

The government is aware of the risks.

Appearing before the House of Commons public accounts committee on November 5, Jon Thompson, chief executive of Her Majesty’s Revenue and Customs, listed “customer readiness” as one of the greatest no-deal risks.

“We are not going to be naïve about whether businesses will be ready for day 1, no deal,” he said. “That is currently rated red. To some degree, customers will not be ready for what would happen in the event of day 1, no deal.”

The consequences

In other words, the risk of no-deal disruption is real, and so therefore is the risk of goods shortages.

Concerns about food and medicine availability are well-documented, but even in these vital areas there remains uncertainty that enough has been done.

Representatives of pharmaceutical firms and the NHS warned Health Secretary Matt Hancock on October 31 that if a damning National Audit Office report on the state of government planning was correct, then “we will have widespread shortages if we do not respond urgently.”

British Prime Minister Theresa May leaves 10 Downing Street | Jack Taylor/Getty Images

As for food, the shelves will not be bare, Wright said, but added he is aware of firms already stocking ingredients from Europe that might become temporarily inaccessible in the event of no deal.

If the disruption lasts longer than a month or so, he said, there are “very, very few businesses which could stockpile enough of their ingredients or products this side or the other side of the Channel to be able to bulletproof themselves.”

“I think there will be businesses who through no fault of their own will be put at very serious risk,” he said.