A health assessment of the UK-US trade deal with Donald Trump warns it could cause more deaths than the Covid-19 pandemic, as NHS funds are diverted to pay higher drug prices. The analysis by Liverpool University researchers, published in the British Medical Journal, predicts 229,000 excess deaths by 2036 if funding is redirected from other NHS care. Including indirect effects on adult social care, the figure rises to 291,000, compared to 137,000 Covid-19 deaths between March 2020 and June 2022.
Financial Impact and Opportunity Cost
To meet the deal's terms, the government must find £45 billion in NHS funding by 2036 to pay US pharmaceutical companies higher prices. President Trump threatened tariffs on UK drug imports if the NHS did not buy more expensive American medicines. The NHS's collective bargaining power has historically secured lower prices than US private hospitals. Author Andrew Hill from Liverpool University's Department of Pharmacology noted, "In publicly funded systems with finite budgets, higher spending in one area inevitably takes away the opportunity to spend elsewhere. This makes decisions about medicine pricing fundamentally decisions about how healthcare resources are allocated."
Changes to NICE Thresholds
From April 2026, the government instructed the National Institute for Health and Care Excellence (NICE) to raise its cost-effectiveness threshold from £20,000-£30,000 per quality-adjusted life year (QALY) to £25,000-£35,000. The deal commits to more than doubling spending on new medicines from 0.3% to at least 0.6% of GDP by 2036. While this may approve costly drugs for cancer and other conditions, researchers argue it primarily increases prices for existing medicines rather than expanding the range of drugs prescribed. NICE already approves 90% of medicines it evaluates, with the change expected to add only two to five additional approvals annually.
Industry Pressure and Transparency Concerns
Pharmaceutical giants including AstraZeneca, Lilly, and Merck paused £1.3 billion of UK investment last year, and Merck scrapped a £900 million R&D centre, citing Trump's threats. The government conducted an impact assessment but has not made it public. The study calls for full disclosure, stating, "The government's willingness to accommodate industry pressure while the NHS absorbs the resulting costs raises important questions about transparency and accountability." Campaigners from Just Treatment and Global Justice Now have written to Health Secretary James Murray opposing the deal. Tim Bierley of Global Justice Now said, "The Trump medicines deal risks taking a wrecking ball to our health and our economy. Billions that could be spent on recruiting more NHS staff, cutting GP waiting times, or improving our hospital care are set to be siphoned off by corporate giants." The Department of Health and Social Care was approached for comment.
