Why Brexit Could Make the U.S. a Refuge for Sick Europeans Lacking Drug Access

Brexit European Union flag London
A European Union flag in front of Big Ben outside the British Parliament, March 28. Stefan Wermuth/Reuters

As Britain prepares to leave the European Union, the European Medicines Agency is preparing to move from its London headquarters. The agency is responsible for evaluating new medications, so the move leaves EU citizens in limbo where accessing drugs—both new and already approved—is concerned.

Nineteen EU cities are vying to be the future home of the EMA. On Saturday, the European Commission released a study on the impacts of these 19 cities, prioritizing each based on six criteria, including the assurance that the agency's operations will continue after the UK leaves the EU in March 2019.

However, a survey of nearly all current EMA staffers revealed that even if the agency moved to the city favored by the highest proportion of employees, not enough would move with it to maintain all public health activities. That city was not identified in the survey, nor was the least favored city, to which 94 percent of EMA staff said they were not likely to relocate. (Reuters reports that Barcelona, Vienna and Amsterdam are among the top EMA staff picks, but Newsweek has not verified the information.)

Even if the majority of the agency does relocate, it could take two or three years for the regulator to fully recover. Ultimately, the move could mean Europeans' access to medications—either those waiting for approval or those already on the market—could be compromised.

Since rejoining the U.S. FDA earlier this year, commissioner Scott Gottlieb has put a premium on speeding up approvals, especially for generic drugs. If that initiative holds, the U.S. may become a haven for those seeking medications not available in their own countries. In other words, the country could become the next medical tourism hotspot.

European Medicines Agency Headquarters
The headquarters of the European Medicines Agency (EMA), is seen in London, Britain, April 25, 2017. REUTERS/Hannah McKay

American hospital systems have long courted overseas clientele willing to pay full freight for their medical care. Some of the most well-known U.S. hospitals, including the Cleveland Clinic, the Mayo Clinic and Massachusetts General Hospital, have made clear overtures to international patients.

"They come both for general evaluations—kind of comprehensive general checkups—as well as for highly-specialized treatments that may or may not be available in their home countries," said Misty Hathaway, the senior director for international and specialized healthcare at Massachusetts General. That includes visits to experts who may have pioneered procedures or specific treatments.

Hathaway is unsure how or if the EMA's relocation might affect her hospital's operations or patient population. However, she confirmed, international patients also come for certain medications that have only been approved in the United States. "Yes, definitely, we see that. Certainly for highly-specialized cancer treatments, some neurological conditions or digestive diseases."

This kind of tourism actually has a name: circumvention tourism. The term is more commonly applied to tourists who are looking to avoid penalties associated with medical procedures—like women who travel to England from Ireland for abortions. However, medical ethicist Jeremy Snyder, a professor at Simon Fraser University in Vancouver, Canada, has also used the term to refer to patients seeking unapproved treatments.

If the EMA does lag behind the FDA and more Europeans travel to the U.S. for medications, "it would fit a pattern that we've seen elsewhere for sure," Snyder said.

"Any time one jurisdiction is falling behind and you have a reputable agency approving it in another jurisdiction, you're going to have people heading over to access it," he said. For example, Snyder noticed Americans who wanted a particular prostate cancer treatment traveled to countries where it was approved, which included Canada and the Bahamas, to get it. He's also seen some Canadian patients travel to the U.S. for stem cell procedures they cannot readily find at home.

Of course, no European patient should think about booking a plane ticket right now. Any potential issues are still theoretical until the EMA's new home is announced in November.