It has been extensively argued that the United Kingdom’s impending departure from the European Union (EU), “Brexit,” will have a major impact on the National Health Service and the scientific community in the United Kingdom. The consequences of such a scenario are expected to be severe. Without an agreement on future cooperation and collaborations, prospects are that the United Kingdom will lose access to EU research funding programs, which could significantly weaken the British scientific community.
An immediate result of a no-deal Brexit will be a lack of access to the Horizon 2020 funding, EU’s major research funding scheme. Within the Horizon 2020 program, UK-based researchers have access to around €1.3 billion per year. Furthermore, the United Kingdom will probably not have access to the next EU research and innovation program “Horizon Europe,” for which a budget of €94.1–120 billion for the years 2021–2027 has been proposed.1,2 In addition, UK-based foreign scientists, including postdoctoral researchers and graduate students, especially those from the EU, face uncertainty with regard to their legal status in the United Kingdom, threating research productivity. Moreover, a large group of researchers with an EU-background may consider returning to the European mainland, together with their personal funding and networks.3
With the above in mind, the consequences for the United Kingdom’s involvement in transplantation research, in both Europe and globally, remain uncertain. The current literature does not provide an analysis of the United Kingdom’s involvement in (transplantation) research projects and scientific publications, or on the consequences of global research collaborations.
Considering these major changes in the scientific landscape, and the fact that organ transplantation crosses many borders, we provide an overview of the allocation of EU-funding in the EU and the potential loss of international research collaborations in case of the Brexit.
The data of EU-funding for transplantation research clearly shows the dependence of the UK transplant community on EU-funding: From 1988 to 2019, 135 projects focusing on transplantation research received EU-funding, with a total budget of €292 million. The 4 largest EU countries, based on population size, received the largest part of the funding budget, with 26.8% (€78.3 million) going to Germany, 17.1% (€49.8 million) to France, 12.0% (€35.0 million) to Italy, and 10.7% (€31.4 million) supporting United Kingdom research. Stratifying projects based on coordinating countries show that the United Kingdom is one of the 5 leading coordinators of EU funded projects on transplantation research (Figure 1) (France 17.8%, Germany 14.8%, United Kingdom 14.1%, Spain 10.4%, and Italy 9.6%).
These numbers indicate the strong link among EU-member states, with the involvement of UK-based researchers in 47.4% of the EU-funded projects (14.1% as coordinating country and 33.3% and participating country). Participation of UK-based researchers was mostly seen in projects coordinated by Germany (28.9%), France (22.2%), and The Netherlands (13.3%) (Figure 2).
When assessing the scientific output in the transplantation community, the United States has been the largest contributor (17 277 publications) followed by Germany (3179 publications), with the United Kingdom ranked third (2766 publications).
Approximately 20% of scientific publications by United Kingdom primary authors are the result of an international collaboration, with a multiple/single-country ratio of 0.19 (the number of publications by authors based in different countries as a proportion of the total number of publications). The worldwide median (interquartile range) multiple/single-country ratio that characterizes the number of publications by authors from different countries as a proportion of the total number of publications, was 0.20 (0.15–0.30), with the highest ratio for Norway (0.35), the lowest ratio for Pakistan (0.00), and a ratio of 0.19 for the United Kingdom (Figure 3). When reviewing these international collaborations, the United States (n = 306, 7.6%), Denmark (n = 139, 3.4%), Germany (n = 121, 3.0%), The Netherlands (n = 113, 2.8%), and France (n = 102, 2.5%) were identified as the most relevant scientific allies of UK-based authors, 4 of which are part of the EU (Figure 4). Including scientific publications as participating authors, UK-based authors contributed to 4017 (4017/42 628, 9.4%) publications.
THE IMPACT OF BREXIT
Earlier publications on the effect of the dawning Brexit on international scientific collaborations and research output point to the high probability of a negative impact in the first years after Brexit.4-6 In 2017 and 2019, Fahy et al5,6 provided an extensive analysis of 4 possible Brexit scenarios, with (1) a no-deal Brexit; (2) a withdrawal agreement; (3) the Northern Ireland Protocol’s backstop, an option assuring that the border between the United Kingdom (Northern Ireland) and Ireland remains open; and (4) a political declaration on the future relationship between the United Kingdom and EU.
Currently, we see 3 possible options: (1) a withdrawal agreement (deal); (2) no deal; or (3) a revoke of #50 (no Brexit), albeit the latter seems to be improbable.
With the first scenario, EU-funding and collaborations, including a legal framework, will stay in place until December 2020. Both sides will aim for continued UK and EU research collaborations; however, terms are expected to get more challenging for the United Kingdom.
The second scenario will end EU-funding and stall EU collaborations. Considering the most current political climate, the no-deal scenario seems far more likely than a revoke of #50. However, The British Medical Association, British Medical Journal, and the Royal College of Nursing continue to insist on a second Brexit referendum.7 A second referendum or a revoke has, however, been thus far declined by the Government.
Current evaluations show that all variations of Brexit will have negative consequences for the United Kingdom’s position in healthcare and health-related research, with the most detrimental effect in case of a no-deal Brexit.
As the United Kingdom is a significant beneficiary of EU-funding, the United Kingdom government announced their efforts to guarantee EU-funding beyond the official Brexit date, at least up to the end of Horizon 2020.8 The United Kingdom government also announced to explore the possibility of creating an international research fund to fill the gap when EU-funding opportunities are lost after Brexit.9 From a scientific perspective, allowing Britain to participate in the Horizon 2020’s successor “Horizon Europe” as an “associated” country is expected to significantly limit Brexit’s impact. The status of “associated” country would enable UK-based researchers to be part of European Research Council projects, a status currently held by non-EU countries such as Norway and Switzerland. However, a series of side-deals and compromises will be essential to soften the blow on research and innovation for both the United Kingdom and the EU.
From a clinical perspective, Brexit could have a forceful impact on organ donation and transplantation in the United Kingdom. While international donation and transplantation societies are thriving, UK-based researchers could face difficulties when pursuing international collaborations.10 Shapey and coworkers detailed the areas of potential impact on clinical transplantation in case of a Brexit extending to (1) existing EU-wide legislation; (2) regulation and governance, with requirements and standards of quality and safety for organs; (3) existing organ-sharing networks; (4) pan-European initiatives, including EU-funding for research and cross border initiatives to increase donation rates; (5) EU efforts to combat organ trafficking and transplant tourism; and (6) legal status for EU-citizens working as clinicians and/or researchers in United Kingdom transplant centers.11
With nearly 11% of transplantation research-related EU-funding and the involvement of UK-based researchers in almost half of all EU-funded projects, the United Kingdom plays an important role in transplantation research, and UK-based researchers have an important position within the EU research community.
Brexit, the United Kingdom’s impending departure from the European Union, is expected to have a detrimental impact not only the scientific community in the United Kingdom but also on the continental European countries.
We would like to thank Brexit experts Mrs. Eline van den Berg—Veldkamp (Veldkamp Consulting B.V.) and Mr. Raimond Nicodem (Nicodem & Company) for their valuable and constructive comments.
1. EU Commissioner for Research, Science and Innovation CM. Statement by Commissioner Moedas on the European Parliament’s vote on Horizon Europe. European Union. 2019. Available at https://clepa.eu/mediaroom/statement-by-commissioner-moedas-on-the-european-parliaments-vote-on-horizon-europe
. Accessed May 1, 2019
2. European Parliament. Amendments adopted by the European Parliament on 12 December 2018 on the proposal for a decision of the European Parliament and of the Council on establishing the specific programme implementing Horizon Europe - the Framework Programme for Research and Innovation. (COM(2018)0436 – C8-0253/2018 – 2018/0225(COD)). 2018. Available at http://www.europarl.europa.eu/doceo/document/TA-8-2018-0510_EN.html
. Accessed May 1, 2019
3. Torjesen I. Four in 10 European doctors may leave UK after Brexit vote, BMA survey finds. BMJ. 2017; 356:j988
4. Begum M, Lewison G, Lawler M, et al. The value of European immigration for high-level UK research and clinical care: cross-sectional study. J R Soc Med. 2019; 112:29–35
5. Fahy N, Hervey T, Greer S, et al. How will Brexit affect health services in the UK? An updated evaluation. Lancet. 2019; 393:949–958
6. Fahy N, Hervey T, Greer S, et al. How will Brexit affect health and health services in the UK? Evaluating three possible scenarios. Lancet. 2017; 390:2110–2118
7. Rimmer A. BMA repeats its call for second Brexit referendum. BMJ. 2018; 363
8. Gov.UK. Chancellor Philip Hammond Guarantees EU Funding Beyond Date UK Leaves the EU. 2016. Available at https://www.gov.uk/government/news/chancellor-philip-hammond-guarantees-eu-funding-beyond-date-uk-leaves-the-eu
. Accessed September 14, 2018
9. Gibney E. UK considers post-Brexit research fund open to world. Nature. 2019. Available at http://www.nature.com/articles/d41586-019-00808-4
. Accessed March 7, 2019
10. Neuberger J. Brexit and transplantation does anyone win? Clin Transplant. 2018; 32:e13327
11. Shapey IM, Summers AM, Simkin IJ, et al. When politics meets science: what impact might Brexit have on organ donation and transplantation in the United Kingdom? Clin Transplant. 2018; 32:e13299