In climate change, AIDS, tobacco control, and many other areas, the phenomenon of denialism is well established. To this list we can now add Brexit

Word has it that the UK’s prime minister Boris Johnson wants the word “Brexit” to be consigned to the history books at 11pm on the 31st January 2020. He will have “got Brexit done,” allowing his government to move on to the measures needed to “make Britain great again” as the United Kingdom takes back control of its “laws, borders, money, and trade.” 

The event will be commemorated by issuing a new 50 pence coin, identical to the 3 million manufactured for the most recent Brexit day, in October 2019, which had to be melted down when it was delayed. It will also be accompanied by a light show in Downing Street but not, to the frustration of many Brexit supporters, by the chiming of Big Ben. Johnson had proposed a crowd funder to raise money to allow the bell, currently surrounded by scaffolding, to ring out or, as he put it, “bung a bob for a Big Ben bong”. But throwing money at the problem was not enough. As he conceded when proposing the idea, “I haven’t quite worked it out yet.” 

It now seems that this is not the only thing that he hasn’t quite worked out. Immediately on taking office as prime minister he spoke of the “clear plan we have prepared to give every older person the dignity and security they deserve,” leading many to believe that the long awaited response to the crisis to social care was imminent. It was not, and it may not appear for up to 5 years. But what about Brexit? Has he really got it done? 

In one respect he has. The Withdrawal Agreement has been signed, and on 1st February 2020, the UK will no longer be an EU member state. It will have no Commissioner or MEPs and will not attend the Council of Ministers. But otherwise, not much will change. The UK will move to the next stage, lasting until 31st December 2020. During this time, the UK will remain in the Single Market and Customs Union. Free movement will continue. And the UK will continue to apply EU law, something that seemed to come as a surprise to one Brexit Party MEP. 

This phase is described in the Withdrawal Agreement as a transition period, but by the UK government as an “implementation period”. This begs the question of what it is that will actually be implemented. Answering it has assumed some urgency because, although the Agreement allows for the period to be extended, Johnson has resolutely ruled out the possibility of doing so, enshrining his commitment in legislation. And there is rather a lot to do in a very short time. 

The first problem, and one which has so far evaded a solution, involves the UK government deciding what it actually wants. Put simply, if the UK decides that it wants to remain aligned to EU rules then the task of delivering frictionless trade with the EU (and crucially, between Great Britain and Northern Ireland) could be achievable in the time available. If, however, it wants to diverge from the EU, then the task becomes vastly more complex. Unfortunately, ministers seem to have very different views, in some cases contradicting themselves over a matter of days. These disagreements reflect differing views on many things but, particularly, the priority that individual ministers give to reaching trade deals with, on the one hand, the EU, and on the other, countries such as the USA and those in the Commonwealth. The USA has made it clear that it wants major concessions in areas such as agriculture and pharmaceuticals, yet the former in particular would require substantial divergence from EU standards. A further problem is the willingness of the USA to pursue its protectionist agenda through pressure on third countries, exemplified by the pressure on the UK to exclude Huawei from the UK’s 5G network. Then there is the problem of resolving differences between government departments. Should the Department of Health and Social Care lead on pharmaceutical policy, emphasising affordability, or should it be the Department for Business, Energy and Industrial Strategy, emphasising profits?

Unfortunately, there are few reasons to think that meaningful agreement within government on the UK’s future relationship with the EU is possible. If it has not been reached in over three years since the referendum, why would we think it will happen now? And any agreement must be grounded in reality, something that has been severely lacking on the UK side. Only a few weeks ago the prime minister said that there would “emphatically” be no checks on trade across the Irish Sea, a claim that is demonstrably false. 

A further challenge will be reaching any agreement with the devolved nations. The Scottish, Welsh, and Northern Irish legislatures have already rejected the Withdrawal Act. While, in strictly legal terms, the Westminster government can ignore them, there are many practical problems. For example, the Irish government insisted that the Withdrawal Agreement committed the UK not just to enact laws but to implement them. These include the creation of the necessary physical infrastructure at Northern Irish ports of entry to make the many complex checks on goods that will be required. Yet the new Northern Irish agriculture minister has said simply that “we have no intention of putting infrastructure in place”. 

But maybe we should suspend our disbelief and assume that, somehow, the UK will develop a negotiating position that is coherent and achieves widespread acceptance, at least within the Conservative Party even if not within the four parts of the UK. What comes next? 

First, it is necessary to complete the withdrawal process. This is more complicated than it seems as many of the most contentious issues were parked, to be dealt with later, to ensure that an agreement could be reached. Among them, perhaps the most problematic is fishing. Put simply, much of the fish caught in British waters is exported, largely to the EU. Much of the fish eaten in the UK is imported. The UK wants the two processes to be decoupled, so that it can exclude foreign vessels from British waters, ironically by contracting with a French company to enforce this policy, while maintaining freedom to export its fish to European markets. The EU views the two issues as linked. So do the owners of French fishing vessels who, crucially, have the ability to blockade the port of Calais, threatening severe food shortages in the UK. To add to the complications, the EU is now seeking to link access to UK waters to the ability of UK financial institutions to operate in the EU, forcing the British government to make a very difficult political choice. Crucially, this must be resolved by July 2020.

Citizen’s rights are another area of unfinished business. Again, the government seems unable to reach consensus on what it wants and the EU, well aware of the Windrush scandal, is concerned, especially as it sees the UK government taking steps to water down protections it had committed to. The prime minister’s recent announcement of a new “global talent visa” was soon revealed to be a relaunch of an existing scheme and did nothing to address the high costs and bureaucratic obstacles that characterise the UK’s immigration regime. 

Then there is a raft of legislation to be passed, and as importantly, to be implemented, in some cases creating new regulatory structures from scratch. Existing bodies, such as the Medicines and Healthcare products Regulatory Agency, will have to duplicate much of the work done currently by EU institutions. 

All of these issues have to be addressed before getting to the process of agreeing the UK’s future relationship with the EU. The prime minister’s deadline to complete this process is widely viewed as completely unrealistic, given the complexity of the task, coupled with the UK’s lack of clarity on what it wants. A recent report by the Institute for Government sets out in detail the challenges that lie ahead. 

Given the narrative being promoted, that Johnson has “got Brexit done,” we can expect to hear very little about it over the next few months. The prime minister has already taken steps to prevent any public scrutiny of the process. In contrast to Theresa May’s proposals, Parliament will have very little say in what is being done, with policies largely determined by ministers. The government seems in no hurry to establish new parliamentary select committees, some of which were very effective in holding the government to account in the last parliament. Ministers are refusing to appear on flagship broadcasting platforms. We can expect a continuation of the secrecy that has shrouded the UK’s actions, in marked contrast to the transparent approach adopted by the EU. 

Meanwhile, we can expect the harmful consequences of Brexit to continue to unfold. Global corporations will continue to move investments, and jobs, out of the UK. Increasing numbers of essential workers, especially in the NHS, will leave and few will want to replace them. Anyone involved in any way with the EU will find problems that were unforeseen or, more likely, foreseen but disregarded. And just as they have done previously, when faced with news of companies relocating to the rest of the EU, ministers will argue that there were many other reasons. Already, they are creating a narrative that some industries, such as automobiles, aerospace, and pharmaceuticals are in “secular decline.” For the public health community this argument is very familiar. For years, the tobacco industry sought to persuade us that there were many other explanations for the harm caused by its products. How can we know that smoking caused cancer, or Brexit caused economic decline, when so many other things were happening? In climate change, AIDS, tobacco control, and many other areas, the phenomenon of denialism is well established. To this list we can now add Brexit. As with other upstream threats to health, the public health community will have a key role to play in documenting its effects and establishing the complex, but still identifiable causal pathways. And even if the prime minister won’t be talking about Brexit, we will, and for a long time to come.

Martin McKee is professor of European public health at the London School of Hygiene and Tropical Medicine.