British di­a­bet­ics fear in­sulin cri­sis in no-deal Brexit

Their coun­try im­ports most of its sup­plies from the free-trade bloc it is leav­ing

The Washington Post Sunday - - THE WORLD - BY KARLA ADAM AND WIL­LIAM BOOTH [email protected]­post.com wil­[email protected]­post.com

glas­gow, scot­land — Neil Mac­dougall has had Type 1 di­a­betes al­most as long as he can re­mem­ber. He wears a pump on his hip, the size of a mo­bile phone, that drips in­sulin into his body. It’s as pre­cious and nec­es­sary to him as air.

Mac­dougall says he stays on top of his con­di­tion. But he’s wor­ried about what hap­pens af­ter Brexit. Nearly all the in­sulin in Britain is im­ported, the bulk of it from Den­mark. If Britain crashes out of the Eu­ro­pean Union in March with­out a deal for how to man­age the with­drawal, drugs that keep him alive could sud­denly be hard to get. With­out in­sulin, Mac­dougall fig­ures, he’d be dead in 48 hours.

“It’s all very well for politi­cians just sit­ting in ivory tow­ers say­ing, ‘We will get through this with a bit of courage and a bit of hope.’ Courage and hope don’t con­trol my blood su­gar lev­els,” said Mac­dougall, 44, a telecom­mu­ni­ca­tions en­gi­neer who works in Glas­gow.

Britain is get­ting wob­bly in the knees as it faces what was once un­think­able: leav­ing the E.U. with no deal, no tran­si­tion pe­riod, noth­ing to re­place a sys­tem that has pro­vided fric­tion­less trade for more than 40 years.

The British news­pa­pers have been a lit­tle hys­ter­i­cal, re­veal­ing plans, for ex­am­ple, to evac­u­ate the queen from Buck­ing­ham Palace in the event of mass ri­ots in Lon­don stoked by empty gro­cery­s­tore shelves.

Hard­core Brex­i­teers dis­miss it all as pro­pa­ganda gen­er­ated by “project fear” Europhile cam­paign­ers. But just be­cause some fears may be ex­ag­ger­ated doesn’t make oth­ers less real. And grow­ing num­bers of pa­tients, doc­tors, phar­ma­cists and hos­pi­tal ad­min­is­tra­tors are wor­ried about what a “no deal” Brexit could mean for medicines and med­i­cal sup­plies reach­ing this is­land na­tion.

There doesn’t ap­pear to be ap­petite in Westminster for a cliffedge Brexit. Par­lia­ment last week voted to as­sert that Britain should not leave the E.U. with­out a deal. Still, the cur­rent le­gal de­fault po­si­tion is that the coun­try will exit the bloc on March 29, with or with­out a deal.

Most an­a­lysts agree that a nodeal de­par­ture would be dis­rup­tive, at least in the short term.

Overnight, Britain would lose its sta­tus as part of the E.U.’s sin­gle mar­ket and cus­toms union, and it would be­come sub­ject to third­coun­try rules. Trucks car­ry­ing food and medicine could face new bor­der checks. The Road Haulage As­so­ci­a­tion, a trans­port in­dus­try body, has warned of “dis­as­trous queues at ports” if Britain doesn’t exit smoothly with a deal.

For those who rely on life­sav­ing medicines, the thought of roads to and from ports turn­ing into park­ing lots is dis­tress­ing.

As with many sec­tors, health care is deeply in­te­grated across Europe, with so­phis­ti­cated “justin-time” sup­ply chains unit­ing the 28-na­tion bloc. Up to three-quar­ters of all the drugs used by Britain’s state-run Na­tional Health Ser­vices come from or through the E.U.

British of­fi­cials have is­sued as­sur­ances that if the coun­try were to leave with­out a deal, pa­tients will con­tinue to re­ceive the drugs they need — even if that re­quires the gov­ern­ment to pri­or­i­tize med­i­cal sup­plies over food.

“Of course, medicines will be pri­or­i­tized,” health sec­re­tary Matt Han­cock told a par­lia­men­tary com­mit­tee. “We have been through de­tailed, line-by-line anal­y­sis of the 12,000 li­censed medicines in the U.K. to en­sure there is a plan for the con­ti­nu­ity for all medicines in the event of a no-deal Brexit,” he added.

As part of its no-deal con­tin­gency plan­ning, the gov­ern­ment has asked drug com­pa­nies to stock­pile six weeks’ worth of medicines on top of their nor­mal sup­plies. It is look­ing into char­ter­ing planes to fly in medicines and adding ca­pac­ity to var­i­ous ship­ping routes across the English Chan­nel. It has pur­chased some 5,000 re­frig­er­a­tors for med­i­cal stor­age needs. “I’ve be­come the largest buyer of fridges in the world,” Han­cock told the BBC.

What the gov­ern­ment does not want is for in­di­vid­u­als to do their own hoard­ing. Of­fi­cials have dis­cour­aged pa­tients and phar­ma­cists from stock­pil­ing and told doc­tors not to write ex­tra pre­scrip­tions.

“Do­ing so risks short­ages for other pa­tients,” warned Stephen Ham­mond, Britain’s health min­is­ter tasked with Brexit plan­ning. “If ev­ery­one does what they are sup­posed to, we are con­fi­dent the sup­ply of medicines will con­tinue un­in­ter­rupted what­ever the Brexit out­come.”

The prob­lem is that pub­lic trust is in low sup­ply as peo­ple watch their gov­ern­ment and a di­vided, squab­bling Par­lia­ment strug­gle to agree on a Brexit deal.

“Fun­da­men­tally, we need to go be­yond the gov­ern­ment say­ing, ‘Don’t worry, we have a plan, but we can’t re­ally tell you about it,’ ” said Robin Hew­ings, head of pol­icy at Di­a­betes UK.

Mark Dayan, a pol­icy an­a­lyst at Nuffield Trust, a health-care think tank, as­sessed that gov­ern­ment prepa­ra­tions “would prob­a­bly pre­vent . . . re­ally wide­spread short­ages im­me­di­ately.” Still, he said, “Peo­ple are prob­a­bly right to worry.”

“It’s go­ing to be very dif­fi­cult to 100 per­cent guar­an­tee that noth­ing goes wrong in such a chaotic and untested sit­u­a­tion,” Dayan said. He noted that be­yond test­ing med­i­cal sup­plies, a no-deal Brexit could con­trib­ute to ris­ing med­i­cal costs if the pound falls, and could cause per­son­nel short­ages at hos­pi­tals aban­doned by E.U. nurses, and more strain on the health­care sys­tem if British re­tirees liv­ing in the E.U. sud­denly lose their Eu­ro­pean health-care ben­e­fits and re­turn home for treat­ment.

Some phar­ma­cists have al­ready re­ported drug short­ages.

“We are on the front line, and we see, on a day-to-day ba­sis, peo­ple com­ing in, quite des­per­ate to get med­i­ca­tion,” said Amo So­hal, owner of Kit­sons Phar­macy in Worces­ter, Eng­land. So­hal said he has no­ticed a sud­den drop in the avail­abil­ity of anti-in­flam­ma­tory painkillers and epilepsy med­i­ca­tion. “I’ve been told, ‘No, there’s no stock avail­able,’ ” he said.

So­hal at­trib­uted the fall in sup­ply, at least in part, to no-deal anx­i­eties. He said he has heard sto­ries of pa­tients and other phar­ma­cies order­ing in bulk be­cause “no one re­ally knows what’s go­ing to hap­pen.”

Mac­dougall, the Type 1-di­a­betes pa­tient, is among those hop­ing to have ex­tra med­i­ca­tion on hand, just in case. He said he has had trou­ble fill­ing his usual or­der of pump parts, though — a sup­ply short­age he sus­pects has to do with stock­pil­ing by oth­ers.

Di­a­betes has be­come one of the most high-pro­file con­di­tions to be high­lighted by Brexit jit­ters, in part be­cause 99 per­cent of Britain’s in­sulin is im­ported, largely from the E.U. It also needs to be re­frig­er­ated, so it can­not sit in­def­i­nitely in traf­fic jams.

“Peo­ple with di­a­betes feel a vis­ceral sense of fear about los­ing ac­cess to their in­sulin,” Hew­ings said. While the phys­i­cal re­sponse varies from per­son to per­son, “if some­one stopped tak­ing in­sulin on a Fri­day, then they would prob­a­bly need to go to the hos­pi­tal by Sun­day.”

It’s “gen­uinely bloody ter­ri­fy­ing,” said James Patrick, 39, a writer whose 7-year-old daugh­ter has Type 1 di­a­betes.

Patrick said he imag­ined that stock­pil­ing in­sulin would be pretty much im­pos­si­ble. “Your doc­tor isn’t go­ing to pre­scribe you a year’s worth. You can’t just buy it, be­cause it is a con­trolled sub­stance, and it’s not shelf-sta­ble,” he said.

Some of the ma­jor phar­ma­ceu­ti­cal com­pa­nies have out­lined backup plans. Novo Nordisk, the Dan­ish drug com­pany that makes most of the in­sulin used in Britain, said it has more than dou­bled its stock and has re­served spe­cial air­freight slots between April and July so that it can fly in­sulin into Britain as needed.

“It never should have come to this,” said Allen Cur­tis, 42, a di­a­betic from Sun­der­land, Eng­land. “Med­i­ca­tion should be the one thing that should never ever be af­fected by what­ever is hap­pen­ing.”

He is con­cerned about di­a­bet­ics ad­just­ing their diet so they need less in­sulin. He knows first­hand how im­por­tant get­ting the ex­act dosage of med­i­ca­tion can be. By the time he dis­cov­ered he had di­a­betes, at age 27, it had ad­vanced to the stage where he was par­tially blind, forc­ing him to leave his job. “Peo­ple are lim­it­ing them­selves be­cause of the threat of a no-deal Brexit,” he said. “That’s dan­ger­ous.”

Ul­ti­mately, peo­ple will be look­ing to Britain’s most high-pro­file di­a­betic: Prime Min­is­ter Theresa May.

Af­ter she re­ceived a di­ag­no­sis of Type 1 di­a­betes, May told Di­a­betes UK: “It does change your life in that you have to make sure you’ve got the right diet and that you’re manag­ing your blood su­gar lev­els, but, be­yond mak­ing sure you’ve got that rou­tine, you just get on with other things ex­actly the same.”

Bri­tons are hop­ing that re­mains true af­ter Brexit.

GARETH FULLER/PRESS AS­SO­CI­A­TION/AS­SO­CI­ATED PRESS

WIL­LIAM BOOTH/THE WASH­ING­TON POST

CLOCK­WISE FROM TOP: Trucks ar­riv­ing from the con­ti­nent or head­ing there are massed at the Port of Dover in Eng­land last month. British of­fi­cials fear that bor­der con­trols ex­pected to snap into ef­fect if a no-deal Brexit oc­curs could cause huge trade dis­rup­tions. In Scot­land, Neil Mac­dougall wor­ries about a po­ten­tial short­age of his in­sulin, made in Den­mark, and parts for his pump, which is from the Nether­lands. There is talk of stock­pil­ing cer­tain drugs so that phar­ma­cies such as this one in Lon­don do not ex­pe­ri­ence short­ages.

SI­MON DAW­SON/BLOOMBERG NEWS

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