A UK-US trade deal to appease Donald Trump could lead to 229,000 deaths by 2036 if NHS funding is diverted to pay Big Pharma more for medicines, it’s been claimed
Britain’s drug pricing deal with Donald Trump will cause more deaths than the Covid-19 pandemic if NHS funds are diverted to pay for it, a new study predicted.
A health assessment of the US trade deal showed it could lead to 229,000 deaths by 2036 if funding was diverted from other NHS care to pay for medicines. The analysis by experts at Liverpool University showed £45billion in NHS funding would need to be found by 2036 to pay US drug companies higher prices. Experts warn the deal to appease President Trump will mean less money to spend on NHS staff and equipment.
President Trump had threatened to impose huge tariffs on drug imports including from UK firms if the NHS did not buy more expensive drugs from US firms. The collective bargaining power of the NHS means it has historically been able to negotiate much cheaper prices than private hospitals in the US.
The new analysis, published in the British Medical Journal, showed without new funding to cover the shortfall, there would be 229,000 more preventable deaths by 2036. If the indirect effect on adult social care is also included, excess deaths increase to 291,000. This compared with 137,000 deaths from Covid-19 between March 2020 and June 2022.
Author Andrew Hill, of the Department of Pharmacology at Liverpool University, said: “In publicly funded systems with finite budgets, higher spending in one area inevitably takes away the opportunity to spend elsewhere.
“This makes decisions about medicine pricing fundamentally decisions about how healthcare resources are allocated, and who the shortfall in funding affects most. This, in health economics is what is known as opportunity cost.”
New drugs for conditions like cancer may help patients gain an extra few years of life but cost more than £1m over the duration of treatment. Until recently, the National Institute for Health and Care Excellence (NICE) tended to reject such drugs as it decided NHS funds would have more benefit spent elsewhere.
From April 2026, the government instructed NICE to increase its cost-effectiveness threshold for new medicines from £20,000-£30,000 per quality adjusted life year (QALY) to £25,000-£35,000. Overall under the deal the government has committed to more than double spending on new medicines from 0.3% of gross domestic profit (GDP) to at least 0.6% by 2036.
It meant some drugs previously deemed not value for money for the NHS will now be prescribed – while pharmaceutical firms will have less incentive to lower prices to get their drugs sold via the NHS. State of the art drugs – such as immunotherapy treatments for cancer costing hundreds of thousands of pounds per dose – are more likely to be approved. However without additional funds to cover the cost, it means less money for staff and critical NHS infrastructure.
NICE already approves 90% of medicines it evaluates, estimating the change will result in only two to five additional medicines being approved annually. Researchers say this suggests the agreement is more likely to increase the prices paid for medicines already entering the NHS rather than substantially increase the range of drugs prescribed.
The government agreed the deal after a number of pharmaceutical giants threatened to withdraw investment from Britain – in light of Trump’s threats – if the UK government did not agree to pay them more. AstraZeneca, Lilly and Merck paused £1.3bn of investment into Britain last year and Merck’s scrapped a £900m research and development centre it had started building here.
The government has undertaken an impact assessment on the wider costs of this trade deal but this document has not been made publicly available. The authors are calling for the full details of the deal and its impact assessment to be published.
The study concluded: “The government’s willingness to accommodate industry pressure while the NHS absorbs the resulting costs raises important questions about transparency and accountability.”
It came as UK campaigners are threatening to challenge the government in the courts over the deal. Patient advocacy group Just Treatment and social justice organisation Global Justice Now wrote to Health Secretary James Murray last month to oppose the move.
Tim Bierley, campaigner at Global Justice Now said: “The Trump medicines deal risks taking a wrecking ball to our health and our economy. Billions that could be spent on recruiting more NHS staff, cutting GP waiting times, or improving our hospital care are set to be siphoned off by corporate giants in the pharma industry.
“As the research shows, if money is diverted from other critical parts of our NHS to pay for this deal, this would lead to hundreds of thousands of deaths. Scandalously, this backroom deal was not subject to any scrutiny in Parliament before being rushed through – and the government refuses to say what impact it will have on the NHS.
“The next Prime Minister must change direction, stand up for our NHS, and unpick the mess left by their predecessors.”
The Department of Health and Social Care was approached for comment.