The triple epidemic of Covid-19, influenza and bronchiolitis this winter, combined with supply difficulties, has weakened an already tense market, making certain molecules inaccessible.
It’s a catchphrase that pharmacists have been telling their suppliers for several months: “I’m calling to see if you have amoxicillin again.” This essential drug, which is by far the most prescribed antibiotic for children, is not the only one to have failed this winter, causing concern in the highest echelons of the State. On February 3, the Minister of Health François Braun promised at the microphone of Europe 1 “a way out of the crisis” within fifteen days. But at the end of last week, pharmacists noted incore of “difficulties” supply, according to Bruno Maleine, member of the council of the Order of Pharmacists.
What drugs are affected?
In all, some 3,000 molecules were missed this winter, according to the National Medicines Safety Agency (ANSM). Among them, those that most concern the authorities, doctors and patients: pediatric versions of amoxicillin, an antibiotic prescribed to treat infections and classified among drugs of major therapeutic interest, and paracetamol.
The situation should improve for amoxicillin in the coming days, say the pharmacists contacted by franceinfo. Regarding the pediatric version of paracetamol, the situation “returned to normal”says Philippe Besset, President of the Federation of Pharmaceutical Unions of France (FSPF).
“Every day we discover a break in a class of drugs, such as cancer drugs, antibiotics, growth hormones, insulins…”
Bruno Maleine, member of the Council of the Order of Pharmacistsat franceinfo
Finally, on the hospital side, medical-sterile devices are also struggling, insists Cyril Boronad, president of the National Union of Pharmacists in Public Health Institutions (Synprefh). These are syringes, needles, catheters, “even more difficult to replace than molecules, because the personnel are trained in a certain type of material”.
What are the consequences for patients?
“I have seen patients travel 20 km because the nearest pharmacies no longer had the medicines requested”says Bruno Maleine, based in the Val-de-Marne. More worrying, a study by the League against cancer, published in September 2020, warns of the loss of chance that these shortcomings can cause for patients. In all, 75% of healthcare professionals questioned by the association affirm that, “despite the existence of substitution treatments, shortages of drugs used against cancer lead to a loss of chances for sick people”. Another study, published in 2019 by the France Assos Santé association, revealed that “45% of people facing these shortages were forced to postpone their treatment, modify it, or even give it up or stop it altogether”.
Is the situation unprecedented?
Yes and no. It’s been about fifteen years since theNational Medicines Safety Agency experiencing shortages. But these periods of scarcity are accelerating: in 2020, 2,446 stockouts were reported, almost three times more than in 2018. There were only 89 in 2010, according to data presented by ANSM to franceinfo in 2020. On the other hand, this is the first time that this concerns drugs intended for the general public.
More generally, “Ihe vast majority of shortages concern so-called mature drugs”clarified Christelle Ratignier-Carbonneil, Director General of ANSM, during a Senate hearing. Understand: those whose patents are free, which makes them less expensive, therefore less profitable and less attractive for the pharmaceutical industry. “They only very rarely concern ‘innovative’ drugs.”
What’s wrong?
Several factors are involved. In 2020 and 2021, during the two years of confinement, the winter epidemics, including those of influenza and bronchiolitis, were not very virulent. However, this year, the triple epidemic of Covid-19, influenza and bronchiolitis was very strong, increasing the demand for drugs.
Another reason put forward: tensions in the drug market with few producers but a lot of demand. In all, “40% of generic drugs are produced by two laboratories in the world”points out the economist Nathalie Coutinet, author of the book Drug economy. In thirty years, the production of 80% of the active ingredients has been relocated to Asia. Particularly in China and India, which in addition to being drug-producing countries are becoming major consumers.
“In the case of amoxicillin, demand has doubled compared to last year, and this increase was not anticipated by manufacturers.”
Nathalie Coutinet, economist specializing in the pharmaceutical marketat franceinfo
Finally, the war in Ukraine and the rise in energy prices have consequences for the production of additives and the packaging of medicines. This is the case of cardboard or glass bottles, used in particular for pediatric versions of amoxicillin and paracetamol.
Is France the only country concerned?
No, many countries have also experienced supply tensions, such as the United States, Canada and European countries. But France has the particularity of being a “very high consumer of drugs, especially for amoxicillin, compared to Germany, Spain, Italy and the United Kingdom”highlighted Christelle Ratignier-Carbonneil in front of the senators.
“Despite a continuous decline for ten years in the consumption of antibiotics, France remains the fourth most consuming European country behind Greece, Romania and Bulgaria.”
Public health Francein a report published on November 2
Do solutions exist?
Initially, the pharmacists’ unions believe that stocks should be established before winter to avoid ordering when demand is greatest. In addition to this short-term solution, they believe that we must agree to pay more expensive drugs and work on a single European price, “like what we did for the vaccine against Covid-19”argues Philippe Besset.
Finally, several voices are raised to insist on the fact that the pharmaceutical industry is strategic. This makes it necessary to relocate production to Europe. “The solution is necessarily European, because each country will not reproduce 500 molecules. We need a European agreement. For the moment this is not the case, because at the height of the crisis, Germany agreed to pay for the more expensive drugs”notes the economist Nathalie Coutinet.
How did the government react?
On Friday, February 3, the government launched an interministerial working steering committee between the Ministries of Health and Industry to better prevent future shortages. Its members will be responsible for identifying a list of drugs “strategic for the health of our fellow citizens”. It will be published “by the end of May”, assured François Braun in a press release.
“Within three months, a white ‘medication’ plan, which can be activated in the event of an exceptional situation, requiring strong measures to be taken to secure the care of our fellow citizens, will be prepared.”
François Braun, Minister of Healthin a press release
A commission of inquiry was also created by the Senate, on the initiative of Laurence Cohen, Communist senator from Val-de-Marne. Finally, at European level, the Commission should present a review of its pharmaceutical strategy in March, according to The world.
I didn’t have time to read everything, can you give me a summary?
Drug shortages are not new. Until now, they only concerned cutting-edge treatments that are little known to the general public. This year, molecules in high demand have been missing, causing concern among patients, doctors and public authorities. These shortcomings are due to tensions in the drug market. However, the Covid-19 epidemic, the war in Ukraine, supply difficulties and an increase in demand have aggravated the situation. The French government is working on ways to prevent future shortages. In the short term, one solution would be to create stocks ahead of epidemic periods, synonymous with high demand, to avoid placing orders at the same time as other countries. In the longer term, players in the sector recommend harmonizing prices at European level, as well as relocating production.