In the field of public health, there is a certain kind of quiet alarm that grows before it goes off in the open. People in Westminster have to read academic papers and letters from hospital consultants about it before they say the word “dangerous” out loud. That alarm is now out in the open. At its heart is a pharmaceutical agreement that is hidden in the UK-US trade framework. Its critics say it trades NHS money for lower tariffs, and a new study suggests it could kill more Britons than the COVID-19 pandemic.
When it was announced in December 2025, the deal secured a zero-tariff window for British pharmaceutical and medical device exports to the US for three years. At the time, ministers called it a landmark in UK-US cooperation. That part seems pretty simple. But as part of the same deal, the NHS agreed to spend a lot more on new brand-name medicines. This will happen by raising the cost-effectiveness thresholds at NICE, changing how health benefits are calculated, and lowering the industry rebate rate from 23% in 2025 to 14.5% under the new rules.
Researchers from the University of York, the University of Liverpool, and Christchurch Hospital in New Zealand did an analysis that was published in The BMJ. They found that these changes will cost the NHS a total of £44.7 billion by 2036. That number is not a guess with big ranges of possible values. The Office for Budget Responsibility says that the GDP will grow by that much, and the government says that it will more than double medicines spending as a share of GDP from 0.3% to at least 0.6% within ten years. Once everything is laid out, the math isn’t too hard. I find it harder to agree with the conclusions.
This is more than just a budget argument because of what that extra spending means in terms of people. Researchers modeled the effects of less NHS capacity, such as delayed treatments, overstretched emergency care, and services that were quietly given less importance, and came up with a number that suggests 229,000 extra deaths could have been avoided by 2036. That number goes up to 291,000 if you count the indirect effects on adult social care. To give you some background, COVID-19 killed around 137,000 people in the UK from March 2020 to June 2022. Let’s take a moment to think about that comparison.
Since the deal was signed, ministers have said that the government’s position is that it gives more people access to medicines that can extend life that they might not have gotten otherwise. Those points of view are valid. NICE does not always approve drugs that are available in other places. The researchers from the BMJ disagree, saying that NICE already approves more than 90% of the medicines it looks at. In real life, raising the cost-effectiveness threshold is more likely to make the NHS pay more for drugs that are already in the system than to let treatments in that weren’t possible before. The access argument has some good points, but they don’t stand up as well when looked at in this way.
There’s also the issue of tariffs. A big reason for the deal was to protect UK drug exports from American tariffs. But later, the US Supreme Court ruled that the proposed tariffs should be lowered from 100% to 10%. This made the economic benefit the UK thought it was buying much smaller. It is now expected that the agreement will cost more than the total value of all medical goods exported from the UK to the US each year, which is about £5 billion, before 2031.
Now, 19 health groups have written to Andy Burnham, who is widely expected to take over as Labour leader from Keir Starmer in a few weeks, asking him to cancel the deal completely. The agreement is called dangerous in the letter that was put together by the SOS NHS coalition and signed by groups like Medact, the Doctors’ Association UK, and Keep Our NHS Public. A retired consultant pediatrician named Dr. Tony O’Sullivan, who is also co-chair of Keep Our NHS Public, said it clearly: about 16,000 people die needlessly every year because of delays in emergency care. He thinks that adding billions more in pharmaceutical obligations on top of that is going in the wrong direction at the worst possible time.
It’s still not clear if Burnham will try to renegotiate the deal or break it if he becomes prime minister. He didn’t answer any questions about it. For sure, it’s getting more expensive for the government to defend this deal than anyone thought it would when it was signed six months ago.
