Just like every other year, midnight on the 31st December 2020 will be a time of mixed emotions. Some will look back fondly on happy times, such as weddings, graduations, and holidays. Some will reminisce about the loved ones they have lost. This time, the latter will far outnumber the former. With a few exceptions, such as those who bought shares in Amazon in January, 2020 will be a year to forget. Hopefully, although it is still too early to be sure, 2021 will be much better. If we are lucky, covid-19 will be under control in large parts of the world, thanks to a combination of distancing measures backed up by well-functioning systems to find, test, trace, isolate and support. Advances in our knowledge of how the virus acts on the body will have given us further therapeutic opportunities, continuing the reductions in death rates already being seen among those who have been hospitalised. On the other hand, by then we may be grappling with a large number of survivors who, in an echo of polio in earlier years, have been left damaged by their illness. If the polls are to be believed, the world will be waiting for the inauguration of President Biden and America’s four year nightmare will be nearing a close, although many may be fearful of the damage that a defeated Donald Trump might do before he leaves, or perhaps is forcibly removed from office. But unless something changes dramatically, people in the United Kingdom will be staring over the edge of a precipice as the country’s Brexit transition process comes to an end. 

Given the massive disruption to our lives in the past few months, it is easy to forget that the Brexit process is still far from over. Yet, just as the diversion of much of the machinery of government in the UK to prepare for a No Deal Brexit left little capacity to prepare for the coming pandemic or, arguably, to realise its seriousness, now it seems that the focus on the pandemic and its aftermath is leaving little room to prepare for the next stage of the Brexit process. 

In these circumstances, it might seem reasonable to consider postponing the finish of the transition period. This would have been possible until the end of June 2020 but, although the EU stated it was open to this possibility, the UK formally rejected it. Boris Johnson remains convinced that everything can be sorted out on time. But can it? Barring a miracle, no.

The first problem is that what was already a very ambitious schedule of negotiations was disrupted by the pandemic. Both lead negotiators, David Frost for the UK and Michel Barnier for the EU, fell ill with covid-19. In London, the problem was aggravated when both the prime minister and the cabinet secretary also succumbed. For several months, any meetings that did take place did so online, eliminating the scope for the chats in corridors that can sometimes overcome an impasse.

Covid-19 was also affecting the mood in the EU27. The remaining 27 Member States are now preparing for the recovery from the pandemic. It is apparent that, despite some notable successes in sharing the burden, the EU could have done better in many respects. It is also clear that there will be a need for European societies to do many things differently in the future, implementing changes that must be paid for. In these circumstances, the seemingly intractable problem of dealing with a departing Member State whose behaviour has frequently seemed like that of a petulant child has, inevitably, slipped down their agendas. Angela Merkel, long one of the strongest supporters of a continuing close relationship with the UK, expressed her frustration in June 2020, noting that the UK “will then have to live with the consequences” of its decisions. 

This fatalism can also be seen on the British side. It was only in May that it published its draft legal text, the basis for negotiations, some months after the EU had done so. Earlier in the Brexit process, the word “cakeism” had entered the language, derived from the old saying of having one’s cake and eating it”. In other words, the UK wanted to retain many of the benefits of EU membership but few, if any, of the obligations. Little has changed. Given that this had been rejected long ago by the EU, who pointed out that it is unusual to allow someone to retain the benefits of being a member of a club once they have resigned, it suggested a lack of serious engagement. Colleagues and I have gone through the two negotiating texts in detail to see where the two sides are on health-related issues. We concluded that “there is a major risk of reaching an agreement with significant adverse effects for health, without meaningful oversight by or input from the UK Parliament, or other health policy stakeholders”. Concerns that the UK may not be taking the negotiations seriously increased when it was announced that its chief negotiator would be taking on a new job shortly, as National Security Advisor. It was not that there was no-one else to take on this other important role. Indeed, as Theresa May commented, he seemed to have “no proven expertise” for it. 

Given these developments, it now seems almost inevitable that we are moving towards a No Deal Brexit. Of course, it will not be called that. Boris Johnson refers to an Australia-style deal, appealing to a sense of nostalgia for the days of Imperial Preference. This conveniently ignores how Australia does not actually have a free trade deal with the EU although, ironically, it may reach one before it does with a post Brexit UK. As a former Australian Prime Minister has noted, the UK is quite low down on her country’s list of trading priorities. 

We have previously set out in detail the threats that No Deal Brexit poses for health. These include economic damage, disruption of supplies of food and medicines, and much else. At the end of 2019, when this seemed likely, the UK began a massive exercise to prepare, including stockpiling of food and medicines. Those supplies are now largely depleted. And just as the UK failed to use the lockdown to prepare for recovery, for example by addressing the needs of schools, so it has failed to put in place the arrangements needed for a No Deal Brexit. Creation of customs infrastructure, whether at the channel ports or in the Irish Sea, has hardly begun. The computerised system to handle trade is still being designed (although in a parallel with the covid app, the French system is already working). And those involved in transporting imports and exports remain largely in the dark about what will be required. 

The long list of failures that have characterised the UK’s, or more accurately England’s response to covid, with unfulfilled promises, ministerial statements before any guidance had been prepared, and a catalogue of procurement disasters, should surely cause any politician to pause and ask whether the country is ready for yet another shock. Yet, as we have seen in the USA and Brazil, populist politicians can do much damage to the health of those who elect them as they pursue their personal agendas. Meanwhile, those who long viewed the UK as an example of good governance that they could aspire to look on in horror.

Martin McKee is professor of European Public Health at the London School of Hygiene & Tropical Medicine and a member of the Independent SAGE convened by Sir David King. He writes in a personal capacity.