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Briefing
Published: 09/10/2026
Author
Mark Dayan
In the past four years, both the UK and the European Union have faced a surge in medicines shortages unprecedented in recent decades. At their most alarming, these shortages have struck the antibiotics that patients need for infectious illnesses prevalent in winter, and crucial products which enable people with long-term conditions such as ADHD and epilepsy to live free from danger and limitations.
There are some signs of recovery or stabilisation. In the UK, current shortages measured across the NHS Specialised Pharmacy Service medicine supply tool by Medicines UK have lessened over the last 18 months. But price rises, global insecurity including the Middle East conflict, and the threat of tariffs are creating a renewed wave of concern about competitiveness, capacity, and the security of supplies in Europe.
In April this year, the Nuffield Trust held a roundtable sponsored by Medicines UK to look at whether the UK could work more closely with the EU in responding to this new reality – and if so, how this could realistically be achieved following the disruption of the UK’s departure, and in the separated legal worlds created by this.
This briefing draws on the event, and further conversations with attendees, officials and experts, to map out three areas where UK-EU cooperation could improve people’s health on both sides. It then summarises recommendations on how the UK government, and independent and representative groups, could try to secure these.
Attendees at the roundtable identified several opportunities where cooperation or recognised alignment with the EU could solve problems facing industry, health care and patients in both the UK and the EU. Some are already well-known and represent tackling longstanding issues since Brexit occurred: others represent a new generation of policy dilemmas driven by new EU policies.
Across the world, batch testing to ensure medicines are precisely as they are supposed to be is the final stage in manufacturing. The fact that the EU does not recognise its validity when conducted in the UK causes several problems.
In the context of shortages, one attendee said it was the key barrier to a world in which “if it’s made in Brussels or if it’s made in Hatfield, it can supply and plug the gap in any member state or the UK”. The lack of recognition for the UK is not a point of general principle: the EU recognises batch testing in the United States. The issue simply lost out in the tense and rapid negotiation of the UK-EU Trade and Cooperation Agreement in 2020.
We heard from attendees that the same issue affects clinical trials – forming a barrier to moving experimental products for patients in a field where 40% of Cancer Research UK’s portfolios of trials cross between the UK and EU. Brexit has already left a difficult legacy for scientific cooperation, with UK participation in funding programmes thrown into doubt and clinical trial sponsors not recognised.
While the UK recognises EU batch testing, EU firms in the supply chain still face added difficulty, because UK manufacturers often contract with EU suppliers for ingredients and services.
Another priority, at a much more operational level, was greater UK-EU cooperation in managing and anticipating shortages. The European Medicines Agency’s Executive Steering Group on Shortages and Safety of Medicinal Products is, for the first time, managing shortages at a trans-national level. The Voluntary Solidarity Mechanism also creates a structure for member states to transfer supplies to one another.
Channels for communication with the UK do exist, and attendees were positive about the mutual interest in sharing information. However, in the absence of formal or political backing, there is a limit to how much cooperation can reliably take place. It is not currently at the level of routinely sharing intelligence or consulting on options to manage shortages by shifting stocks.
A formal memorandum of understanding could give permission for greater openness to routinely share data. It could also incorporate an agreement to stop export bans of medicines between the two jurisdictions.
A third area of possible problems and opportunity is industrial policy. The Critical Medicines Act, finalised during the summer, creates new tools for the EU to subsidise medicines production. It would also allow for member states to preferentially purchase products produced in the EU, where these are critical products with heavy reliance on third countries or known vulnerabilities.
Attendees believed that it remained ambiguous what the status would be for third countries included through the partnership provisions. The final text, now published, notes that EFTA countries should be viewed as on a par with EU member state production, but for critical medicines, it shuts down the possibility that UK-manufactured medicines may also be.
However, even then, EU proposals state that these measures should “be designed and applied in line with the Union’s international obligations”. It may still be possible to take into account location in a reliable partner country offering an alternative to limited existing routes, because the location provisions are part of a wider agenda of letting member states purchase for security instead of value. The same could be argued under the UK’s reformed procurement system. This has crucial implications for whether the UK can approach procurement and investing in medicines capacity alongside EU plans, or needs to assume it is engaged in potentially wasteful competition, where it tries to build up the same capabilities to produce medicines as the EU is already developing.
The UK also has a funding pot covering medicines production with increasing health resilience as one of its two main objectives, the Life Sciences Innovative Manufacturing Fund. Given that diversification from long and fragile supply lines in Asia is seen as a priority by both it and the EU, the underlying logic for a degree of coordination, or at least mutual awareness, is very strong. Put crudely, if the EU and UK both try to reshore manufacturing capabilities for the same kind of products, this gives them fewer options in a crisis than if they are able to spread capacity between them.
Some attendees raised the idea of a joint industrial strategy fund for medicines security, which would fund factories and supply chains in the mutual interest of the UK and EU. This would reflect the Critical Medicines Act’s aspiration for strategic partnerships with third countries in its most ambitious form, with financial commitments from both sides locking in a stable assumption that each would support the other in a period of crisis.
Beyond these specific opportunities, there are three wider reasons why medicines seem to be a promising priority area for changes in the EU-UK relationship:
A brief analysis conducted for this briefing underlines the extent to which medicines shortages are not just a shared problem in general for the UK and the EU, but often relate to exactly the same products. We obtained a list of medicine shortages in 2025 that were serious enough in the UK to result in the publication of a Medicine Supply Notification or National Patient Safety Alert, then cross-referenced them to records of shortage and risk notifications made to the French regulator, ANSM.
This shows that even when we look specifically at the exact dose, pharmaceutical ingredient, and formulation, comparing only powders with powders and slow-release pills with their equivalents, almost half of products in serious shortage in the UK – 41 out of 85 products – had been notified to the French authorities in 2025 or the year before.
The relationship is less clear for insulin, where there were many shortages reported in each country but where the types involved were typically different, and for hormone replacement therapy, where the UK has a particular history of shortages driven by rising prescription. Outside these categories, 38 of the 69 products for which alerts were issued in the UK – a majority – had seen recent notification in France.
This suggests that cooperation on medicines supply and managing shortages could be not just a supporting element, but quite a regular part of dealing with this ongoing problem.
Some of the preconditions for moving closer are in place. The UK government has set a clear general course towards alignment, with the Chancellor stating that “closer alignment is the right course for Britain”. Policymakers are looking specifically at closer cooperation on medicines. Attendees both inside and outside the UK government believed that there was now more dialogue and more warmth and confidence in that dialogue. “A year ago it was almost impossible to speak to anyone in the commission: now that has improved in many, many ways.” In more formal settings, too, we heard that UK and EU officials collaborated more in structures such as forums of regulators. Industry and civil society are generally supportive. But three major barriers exist.
Firstly, there is a fundamental clash on points of principle. For now, the UK government is not proposing to rejoin the single market and take on the full responsibilities of a member of the EU or European Economic Area. This still seems to fall towards the radical end of Andy Burnham’s proposed new options for the relationship, and even if it was fully committed to immediately, it would take several years to become a reality.
In this context, “the problem is that the EU will not let the UK cherry-pick… anything that involves dynamic alignment with the single market, the EU is likely to say no”, one attendee stated. It is certainly possible wider attempts to move closer will make these suspicions more, not less, intense. Each of the specific changes considered above lies within the bounds of relations the EU has previously had with states outside the single market, but the suspicion that they bring the UK too close for comfort will be a meaningful deterrent.
Closely related to this, the EU is committed to a competitiveness agenda. While health security is also a real priority, anything that is seen as an unfair advantage for UK exporters will be strongly resisted. The fact that the UK already accepts EU batch testing in the interests of securing access to medicine means the EU already enjoys one of the most important advantages for competitiveness it could ask for.
Secondly, there is the question of sentiment and priority. A common perspective is that regardless of attitude to the UK, the reality is that it is “far down the priority list” and “not in the room”. Conversations happen, but this does not in itself reflect enough energy to carry changes like these through the multiple bodies and processes which need to align to change EU policy. Pockets of understandable mistrust exist given the UK’s sometimes unpredictable behaviour during Brexit negotiations. Some attendees felt DG Santé, the part of the EU commission with a standing health remit, had been somewhat scarred, though the Health Emergency and Preparedness Authority, now DG HERA, was more amenable.
Lastly, UK decisions since Brexit have created additional complexities. The medicines agreement with the United States to spend more on newer medicines in exchange for tariff relief means that the UK may be seen to have already given its exporters a competitive edge by agreeing to demands that are contrary to EU interests. The fact that the EU has implemented tracking and identification numbers for packages under its Falsified Medicines Directive, while the UK decided not to continue any such measures, creates a standing barrier of administrative complexity and legal risk whenever products move between the two and must be removed from, or added to, the EU system.
This implies a requirement for the UK government, and civil society, to build a case for engagement by demonstrating how it can resolve problems facing the EU, as a substantive enough case for the voice from outside to be heard. The UK needs to be seen as a trusted partner, ready to offer at least its fair share if cooperation is to be deepened, either bit by bit or in a major process marked at one of the now-annual UK-EU summits. Attendees identified four interrelated examples.
The first was that by proactively mirroring EU systems and processes on the licensing pathway of a medicine, the UK could enable the smoothest possible interface for medicines flowing across the two systems. This would be helpful in reducing administrative burdens on EU firms and EU regulators; in making it easier to keep the open border in Northern Ireland as regulations change and evolve; and in making it easier to bring in UK supplies in the event of shortages.
A relatively straightforward field in which to do this would be that the UK makes its standards for digital leaflets to replace the information leaflets in medicine boxes replicate the EU’s emerging “e-PIL” standards. Alternatively, the UK could enact e-PIL earlier as a test for European-wide plans. The UK already imposes significant shortage and discontinuation notice requirements on manufacturers, as well as environmental standards and taxes, which could be said to broadly align with the reformed EU pharmaceutical regulation, aspects of which the UK is required to bring in for Northern Ireland.
Further alignment with this new regulation would need to be considered against the risk of extra costs pushing away NHS suppliers, and making the UK a less attractive place to import products. Roundtable attendees warned that significant extra costs – such as environmental impact assessments on older medicines that sell for pennies – could incentivise firms to simply discontinue supplies in some cases, particularly where UK licence holders are not marketing the product in the EU.
Given the risk of negative impacts on medicine supply, the government should make sure that aligning here was part of a wider agenda for cooperation that benefited UK patients. The UK government should aim to reserve the right to implement with some flexibility for its circumstances, as EU member states often do. Disruptions to medicines supply lines that are specific to the UK would tend to have effects for EU member states as well.
Greater alignment would help to resolve particular problems facing English-speaking EU member states following Brexit. “The English market – the English packaging market – has decreased massively. Ireland is impacted, as are Malta and Cyprus. Joint packaging is where we could come and try to help out.” We also heard from participants that there is in practice a flow of UK medicines to the Republic of Ireland, even as packs are labelled “UK only” at the request of the EU. This is a serious gap in the EU’s system of regulation and control. Regularising this, and sharing monitoring, could meaningfully improve control for the EU.
The UK and EU already have, in Annex 12 of their 2020 trade and cooperation agreement, a commitment to mutually recognise regulatory agency inspections for good manufacturing practice. We heard that a significant problem for the EU is the limits of its capacity to conduct these in originating countries such as Vietnam, India and China. There was a concern that the UK’s departure had worsened this by reducing EU inspection capacity. Commitments for the UK to pick up its fair share, or perhaps a little more, would be both something that it can offer to the EU, and a deepening of mutual reliance that sets the tone for further steps.
Lastly, if the UK shows a firm commitment to genuine reciprocity, the EU should see that it stands to benefit from cooperation on medicines shortages with more opportunities for early awareness of supply problems, and access to a broader supply chain. This might require some political bravery from UK ministers. It would mean, at times, that the interests of EU countries would be considered alongside UK patients when medicines are scarce. But the overall benefits are likely to be greater for both sides.
Building and adopting a package like this would need to be led by the UK government, with substantial political commitment. It would need to be disciplined in its messaging that the interests of the EU matter and are being taken into account. Taking these opportunities to cooperate would substantially improve the UK’s medicines security in several ways, within the limits of what is possible given Brexit. If there is to be a long-term trajectory back towards EU or single market membership, it could help to build the shape of the institutions and industry that would be needed.
It would not be without difficulties. Key elements involve particular trade-offs with other UK interests, in particular any greater alignment with the EU pharma reform package that could disproportionately affect Northern Ireland and the UK’s competitive market, and the risk of enhanced inspections or cooperation draining MHRA (Medicines and Healthcare products Regulatory Agency) capacity that in the post-Brexit years has at times been inadequate for its core roles. These would need to be assessed early.
If protecting health was a serious priority or formed part of a wider deepening of ties, it should be possible to negotiate progress in several areas, as was achieved with the movement of people and energy and emissions at last year’s EU summit.
If building up more gradually is the approach, it would make sense to begin by getting much more ambitious about information sharing. More mutual visibility of risks and supply lines should make it easier to build trust and to see where opportunities to cooperate exist.
Representatives of industry, health systems, and patients across the UK and the EU also stand to gain significantly from these measures. They have valuable assets in delivering them: contacts and interests on both sides of the channel, and the ability to provide independent public support. EU medicines stakeholders are well placed to make the case that EU competitiveness is largely not in opposition to the UK, and could be strengthened in relation to the United States and Asia by having fewer regulatory burdens on trade with its neighbour. Each formal or procedural change relies on an underlying attitude across the now separated worlds of health policy in the EU and UK: that we are in this situation together, and are committed to helping one another improve it.
We are grateful to Medicines UK for providing funding to support the roundtable which informed this briefing. The Nuffield Trust retained its editorial independence throughout.
Dayan M (2026) “Burnham should break down Brexit medicine barriers – here’s how”, Briefing, Nuffield Trust
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