In the past 2 weeks, the sorry state of the political stalemate over Brexit negotiations—the conditions under which the UK will leave the EU on March 29, 2019—have taken a turn for the worse. With 146 days to go, the likelihood of a no-deal or chaotic Brexit has increased into an uncomfortable and alarming region of possibility. This self-inflicted position through a warring, inward looking Conservative Party and an apathetic, inconsistent Labour opposition after 2·5 years of prevarication and posturing risks seriously harming the health and wellbeing of the country's people for generations to come. So what would a chaotic or disorderly Brexit, crashing out of the EU without any deal or agreement, mean for medicine, science, and health?

On Oct 23, a hearing of the health and social care select committee chaired by Sarah Wollaston, an independent-minded Conservative Party member and general practitioner, examined the consequences of a no-deal Brexit for health and social care. With a chaotic exit from the EU, all current legislation and administrative systems governing the import, export, and licensing of medications and devices between the EU and the UK will cease to exist overnight, with unknown but potentially serious consequences on supply chains, quality control, and regulations. In August, the UK Secretary of State for Health and Social Care, Matt Hancock, advised a 6-week stockpile of medicines in the case of a no-deal Brexit. Representatives of the pharmaceutical industry, the National Health Service, and the Healthcare Distribution Association warned, among many other things, that there were not enough cold-storage facilities for vaccines and biologics and that it would take much longer to build these warehouses than the time available.

Additionally, they pointed out that 6 weeks is an optimistic estimate for achieving frictionless trade or alternative supply routes. The words disaster planning, emergency powers, and contingency plans made for uncomfortable listening. Another example with potentially serious effects on patients is the availability of medical isotopes. About 1 million patients each year rely on diagnostic or therapeutic procedures using radioisotopes, 80% of which are imported, mostly from Europe. These cannot be stockpiled as they have a short half-life. The government's answer is to use air transport, which in itself is uncertain in terms of regulation and capacity. Hancock's responses at the committee hearing were robotic and unconvincing. He reiterated that the government does not expect a no-deal Brexit, but it has to be prepared. When asked how confident he is about the preparations, he responded that “I am confident as long as everyone does what they need to do”.

So far, leaders of Britain's medical and science community have been too silent. It was therefore good to see that Venki Ramakrishnan, President of the UK's Royal Society, in a letter to the UK's Prime Minister Theresa May and the European Commission's President Jean-Claude Juncker, signed by 29 Nobel Prize winners, including Paul Nurse, Director of the Francis Crick Institute, and six Fields medallists, urged them to seek “a deal which allows the closest possible cooperation between the UK and the EU, now and in the future”. They point out that Europe, as the home of Enlightenment and the birthplace of modern science, had only recently benefited from a renaissance of collaborative science programmes under the auspices of the EU after the detrimental effects of two devastating world wars. The attempts by some universities to forge bilateral agreement with selected European universities, such as Oxford University with four universities in Berlin, Germany, and Imperial College with the Technical University, Munich, Germany, are a mitigating strategy that is far from the open, collaborative, scientific exchange within the EU that the UK is benefiting from currently. The government's alternative vision of global collaboration rings hollow when visa rules and Home Office practices have hindered scholars and academics from attending scientific conferences.

The monumental historical mistake of Brexit now seems inevitable, although The Lancet would welcome a different decision underpinned by a further referendum based on a new understanding of Brexit implications, as demanded by more than 700 000 demonstrators in London on Oct 20. A Brexit deal with a close alignment to the EU would avert the now all-too-real disaster scenarios for science and medicine. A no-deal Brexit would be a catastrophe with potentially devastating consequences for the health and wellbeing of the UK's people.

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