Between the turkey and the log, we will have talked a lot about the high cost of living and our public services in disarray, but another subject has arisen: the shortage of medicines. From the youngest’s Tempra to the oldest’s EpiPen, via the nice neighbor’s Biphentin, the cousin’s Ozempic or the best friend’s bio-identical hormones, these familiar stories betray a mathematics that has become difficult to support. Over the course of a year, one in five drugs is now out of stock in Canada.
There have always been shortages, but their number and intensity have grown remarkably. From being occasional a few years ago, drug shortages have become a daily challenge for pharmacists. This puzzle could be made a notch more complex by a policy of Republican Ron DeSantis dubbed by Democratic President Joe Biden. After years of struggles, on January 6, Florida obtained authorization to enter our pharmaceutical market in order to take advantage of our very attractive prices.
The first state to obtain approval of a plan intended to offer cheaper drugs to Americans, populous Florida could in reality be quickly joined by other states with similar appetites: Colorado, Maine, New -Mexico or Texas. Sensing the hot soup, the federal Minister of Health, Mark Holland, reacted by recalling the existence of regulations intended to protect our essential supplies.
The Canadian Pharmacists Association fears that these safety nets will prove to be failing under the pressures of an American market hungry for reduced prices. David Renwick, interim president of Innovative Medicines Canada, goes even further. According to him, authorizing the export to the United States of drugs intended for the Canadian population can only cause “harm to our patients” and disrupt “our health system”.
In normal times, the current mechanisms should suffice for the task, but in times of multiple shortages, a healthy doubt arises. Minister Holland will have to be more firm if he wants to convince us; above all, he must demand the immediate review of the mechanisms in place. As long as it has not resolved the equation allowing it to regain a balanced market, Canada will not be able to become the pharmacy of the Americans — or even a simple branch.
As of December 29, 2,975 drug shortages have been reported in Canada in 2023, according to Health Canada data obtained by The Press. And not just for trifles. This staggering list includes all kinds of medications, including several level 3 (the most crucial), with an average break of 98 days.
The pandemic has highlighted an already serious trend, namely rampant offshoring. “Over the past ten years, imports have increased from 74% to 93%, expressed as a percentage of total drug spending in Canada,” wrote York University researcher Joel Lexchin already in 2022, in the Journal of the Canadian Medical Association.
Certainly, we still produce medicines here, but from active ingredients which come overwhelmingly from abroad. China and India control more than two thirds of the global production of APIs, these active pharmaceutical ingredients essential to the production of medicines.
Rest assured, a host of measures already exist to deal with these shortages. But at the cost of an unacceptably cumbersome, complex system. Although there are no studies that quantify the health and economic repercussions of these stock shortages, we see the consequences every day. Substitutions are indeed a complicated art.
For example, some patients respond poorly to substitutions, and the use of suboptimal antibiotics can fuel bacterial resistance. Shortages also weigh on the wallet. Not only are insurers reluctant to reimburse certain plan Bs, but manufacturers sometimes take advantage of a shortage to pay twice, as we saw recently with Ozempic. Out of 4 mg doses, its manufacturer sold two 2 mg pens at double the price of a single 4 mg pen.
Invisible to lay people, the work accomplished by pharmacists to maintain services is used. A recent study by the Federation of Pharmacists of Quebec shows that fatigue linked to workload, already widespread (83%) in the pre-pandemic, has become widespread (93%) with the pandemic. That can not continue.
Faced with problems of similar seriousness, France has launched a vast project, from which our decision-makers would benefit from taking inspiration. Indeed, adaptation measures have their limits. Medicine is at the heart of a gigantic market which must be considered as a whole. Essential to our aging populations, this consumer good is not like the others. Our health independence will depend on how we are able to govern it in the future.