A trade agreement struck last December to shield British pharmaceutical exports from Donald Trump’s tariffs could ultimately cost more lives in England than the Covid-19 pandemic, according to a new analysis that has reignited criticism of the deal’s impact on the NHS.
The study, published in the British Medical Journal by researchers from the University of York, the University of Liverpool and Christchurch Hospital in New Zealand, estimates that the NHS will need to divert £44.7bn from other health services by 2036 to cover the higher medicine prices agreed under the UK-US trade deal, unless the government provides additional funding to cover the gap. That reallocation of spending, the analysis found, would lead to 229,000 excess deaths in England over the period — a toll larger than the estimated 137,000 excess deaths recorded in England between March 2020 and June 2022, at the height of the pandemic. Factoring in the deal’s knock-on effects on adult social care would push the projected toll to 291,000 deaths, with most of the loss of life expected among patients with heart, respiratory and gastrointestinal disease, or cancer.
The origins of the deal lie in a tariff threat that alarmed both the UK government and the pharmaceutical industry. According to reporting by the Bureau of Investigative Journalism, concern first crystallised in early 2025, when Peter Mandelson, then UK ambassador to Washington, warned the then health secretary Wes Streeting of a “big problem coming down track” over pharma tariffs, after Trump signalled he wanted to force manufacturing back to the US and would impose levies on drug imports of up to 100 per cent if the NHS did not agree to pay more. The resulting deal, signed on 1 December, saw the UK commit to paying 25 per cent more for new medicines over the coming decade and to doubling the share of GDP that NHS England spends on innovative therapies, from 0.3 per cent to 0.6 per cent — up from a current annual spend of £14.4bn. Underpinning this, according to the BMJ, the National Institute for Health and Care Excellence will raise the cost-effectiveness threshold it uses to approve new drugs from £20,000–£30,000 to £25,000–£35,000 per quality-adjusted life year from April 2026, while the rebate that drug companies pay back to the NHS when sales exceed agreed limits will be reduced from 22.9 per cent to around 15 per cent.
Ministers have consistently defended the agreement, framing it as a way of protecting UK pharmaceutical exports from US tariffs while giving NHS patients faster access to potentially life-extending treatments they might otherwise be denied. When it was announced, the deal was hailed as a “landmark” agreement to safeguard medicine access and drive investment in the sector. Yet the government’s own public estimate of the cost — an additional £1bn between 2025-26 and 2028-29 — has drawn scepticism, not least because ministers have acknowledged that costs will climb further after that period without specifying by how much. In February, science minister Patrick Vallance confirmed that the bill would fall on the Department of Health and Social Care, and therefore the NHS budget, rather than the Treasury.
This is not the first warning of the deal’s potential toll. Independent health economists raised concerns shortly after it was signed in December, and in April a separate investigation by the Bureau of Investigative Journalism, examining the government’s full spending commitment through 2036 across the whole of the UK, put the total cost at almost £64bn — a considerably higher figure than the BMJ’s England-only estimate, reflecting its wider scope.
The new analysis has drawn a sharp response from health leaders and campaigners. Sir Ciarán Devane, chief executive of the NHS Alliance, which represents health services across England, Wales and Northern Ireland, said the findings raised “serious questions” about whether the deal offered value for patients or the health service, and called for the government’s full impact assessment to be published and properly scrutinised. Liberal Democrat health spokesperson Helen Morgan described the analysis as “alarming” and said it was wrong for billions in NHS funding to go toward what she called placating the US president, arguing the health service needed to be defended “with everything we have.” Campaigners were similarly blunt: Tim Bierley of Global Justice Now said the money could otherwise fund more NHS staff and shorter GP waiting times, while Diarmaid McDonald of Just Treatment said the figures amounted to “a national scandal,” with ordinary patients dying unnecessarily so that drug company profits could rise.
The Department of Health and Social Care has firmly rejected the analysis. A spokesperson said the partnership with the US had reformed medicine pricing and given NHS patients access to life-changing new treatments they would previously have been denied, while helping make the UK one of the best places in the world to develop and manufacture medicines. The department said it did not recognise the £45bn figure, and that the deal would be funded through allocations already secured at the spending review, with future costs to be settled at the next one.
MPs from Labour and opposition parties have continued to press ministers to publish the government’s own confidential assessment of the deal’s likely impact, which has yet to be released or subjected to parliamentary scrutiny since it was agreed.
