Could leaving the European nuclear club put cancer patients at risk?

“What assessment have the Government made of the effect on radiotherapy for cancer patients of their decision to withdraw from Euratom…?”

Pat McFadden MP

“... Let me set out the position: the import or export of medical radioactive isotopes is not subject to any Euratom licensing requirements. Euratom places no restrictions on exports to countries outside the EU so after leaving Euratom our ability to access medical isotopes produced in Europe will not be affected.”

Damian Green MP, 12 July 2017

We don’t know exactly how our ability to access nuclear medical materials will be affected if we leave Euratom—a body which regulates and creates a common market for nuclear materials in Europe. To say that access “will not be affected” by leaving—which is the government’s current intention—seems to overstate what we currently know.

There are two key features of Euratom being debated here: the common market it creates in the trade and transport of nuclear materials, and that fact that Euratom has ownership rights over certain sensitive nuclear materials produced by member states—for instance those that could be used to develop nuclear weapons. Some of these materials are subject to special licenses when trading with countries outside the EU (and Euratom can place restrictions on their use), but this doesn’t extend to the medical materials being discussed.

So leaving wouldn’t produce any particular licensing restrictions on medical radioisotopes, but this doesn't mean there will be no issue in accessing them if we leave Euratom. Simply leaving the common market it creates might make it harder for the UK to guarantee a future supply.

Why people are talking about Euratom and medicine

In January this year, the government introduced a bill to give the Prime Minister the power to start Brexit. That became an Act of Parliament, and paved the way for the Prime Minister to formally notify the EU that the UK was leaving in March.

In a footnote to the bill and later the Act, the government said that not only did it intend to withdraw from the EU, it also intended to leave the European Atomic Energy Community—or ‘Euratom’. That’s been followed up in the recent publication of the Brexit 'repeal bill' and a position paper released setting out the UK's aims on nuclear materials and their safeguards.

Euratom creates a single market for nuclear energy in Europe and regulates the movement of certain nuclear materials. It’s not technically part of the EU, but in practice it is intertwined within EU institutions.

That’s caused some disagreement among legal experts over whether the UK can remain in Euratom while leaving the EU. The European Parliament’s chief Brexit negotiator said recently that this wouldn’t be possible. That said, even without full membership, it’s possible that some form of associate membership could be negotiated.

This matters in medicine because some procedures rely on nuclear materials called ‘radioisotopes’ and their related equipment. They’re used, for example, to diagnose or treat different types of cancer. The UK doesn’t have any reactors that produce these, so we have to import them.

There’s a catch too: some of these materials decay very quickly—within hours or days—and can’t be stored. That’s why we work a lot with nearby countries such as Belgium and the Netherlands to bring the materials in quickly, and delays or disruption to this supply can be costly.

There are concerns that leaving Euratom could disrupt the UK’s ability to do this. This came to prominence last week when the London Evening Standard reported that the government faced a rebellion on the plans to leave Euratom from Conservative MPs. In addition, the Royal College of Radiologists expressed concern that leaving Euratom could threaten the supply of vital medical material to the UK.

The government describes these reports as “alarmist”, causing “unnecessary worry” for cancer patients.

Euratom creates a common nuclear market

Euratom creates a nuclear common market—which is similar in concept to the single market. One function of this is it bans member states from imposing customs controls on the imports or exports of certain nuclear products.

One such product covered is what’s called “artificial radioactive isotopes”, which has been interpreted as including the medical radioisotopes we’ve been discussing.

If that is the case, then member states can’t impose controls on the imports or exports of these isotopes.

So if we leave the nuclear common market, it does open up the possibility that additional barriers to trading these products could be introduced, although it’s not clear how likely that would be in practice.

In addition, the UK may find it harder to guarantee the supply of these materials if there are interruptions in supply, according to the Institute for Government. Euratom oversees the supply chain, and it’s not clear what priority the UK would be given if there were a shortage of supplies. Such interruptions have happened before, and might again in the future.

We don’t know that either of these things will happen if the UK leaves Euratom. A lot will depend on whether transitional arrangements are made, and on what kind of relationship the UK strikes with Euratom from the outside, which will be subject to negotiations.

Euratom also owns certain sensitive nuclear materials

The government’s response to these concerns was set out in fuller form yesterday. Rather than look at the consequences of leaving the common market, it makes a separate point that these medical materials aren’t owned by Euratom so there would be no special restrictions on accessing them if we left:

“We do not believe that leaving Euratom will have any adverse effect on the supply of medical radioisotopes. Contrary to what has been in the press, they are not classed as special fissile material and are not subject to nuclear safeguards, so they are not part of the nuclear non-proliferation treaty, which is the driver of our nuclear safeguards regime”

This particular point is right. The treaty establishing Euratom gives it ownership rights over ‘special fissile materials’ produced in the EU. It also has rights over contracts made for trading these materials from inside the EU or outside.

Special fissile materials don’t include the kind of medical radioisotopes we’ve been discussing, and so—as far as we’ve seen—they aren’t subject to the same rules.

Even so, this doesn’t mean leaving the organisation won’t adversely affect the UK’s access in other ways, as we’ve set out above.

---

Thanks to Marcus Shepheard, a researcher at the Institute for Government, for assistance in writing this article.