Stock-outs of certain drugs are on the rise. Despite the constraint on manufacturers to provide security stocks, the government’s measures are considered insufficient.
The shortage of medicines, very present in recent news, has been a concern for years, but it is increasing and is now affecting widely used medicines.
Which drugs are affected?
For several months, the health authorities have noted supply difficulties for multiple drugs. Two have particularly caught the attention, given their very wide use: paracetamol, painkiller ubiquitous in medicine cabinets, and amoxicillin, by far the antibiotic most given to children.
Concerning paracetamol, concerns go back to the summer. The drug agency (ANSM) has asked pharmacists to avoid selling more than two boxes per patient, even if manufacturers ensure that their production is sufficient to meet needs.
For amoxicillin, it is in its syrup form – intended for children – that the ANSM pointed out supply difficulties last week. The difficulties of the last few months are not limited to these two drugs. Tensions on several antidiabetics were thus reported in September.
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Is this a new phenomenon?
No, but it is getting worse, whether in France or in many other countries. Shortages are a problem that the authorities and the pharmaceutical industry admit to having faced for a long time.
However, the phenomenon is growing. In France, nearly 2,500 risks of stock shortages – or proven shortages – were reported to ANSM in 2020. This is a strong progression, even if the health authorities qualify it by evoking an optical effect: the law increasingly forces manufacturers to signal the risk of shortages upstream.
But proven ruptures are also progressing. “In 2021, 900 supply disruptions were reported throughout the year. There, we are at 600 over a semester, so there is clearly a worsening of the situation ”, underlined this weekend, in Ouest France, Thomas Borel, scientific director of Leem, main French lobby of the pharmaceutical sector.
Why these difficulties?
There are fundamental reasons, and others more circumstantial, which aggravate the phenomenon. The first are linked to the globalization of drug production, a phenomenon that has been accentuated in recent years, resulting in a breakdown of the different stages in multiple sites around the world. “In this context, in the event of a problem on the production chain (…), the risk of rupture is immediately very high”, explained in 2019 the Leem.
Recent news also contributes to seizing up the machine. The industry is penalized by inflation, partly linked to the outbreak of geopolitical tensions since the war in Ukraine. This context affects, for example, access to raw materials or the energy costs of companies.
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Finally, even if the Covid is still there, the epidemic is calming down, and other diseases are returning after being slowed down by confinements and other health restrictions. This is the argument put forward by the French authorities to explain the lack of amoxicillin: according to them, the manufacturers were taken aback by a strong rebound in demand.
In the immediate future, the health authorities are in crisis management. They ration the quantities available in pharmacies, call doctors and patients to discernment. For an antibiotic like amoxicillin, they thus recall that it has no interest against a viral disease like bronchiolitis, in the midst of an epidemic in infants.
In France, manufacturers are also forced to provide minimum security stocks for certain drugs. But the industry, like some critical observers, points out that these measures do not address the root causes of the problem.
The need for a relocation of production is relatively consensus in the speeches, from the government to the industrialists through the analysts, but its extent is discussed. The government has already taken financial incentive measures to “repatriate all these industries which produce these essential drugs”, recalled this weekend the Minister of Health, François Braun.
For some, however, the government is far from ambitious enough. The Observatory of transparency in drug policies, marked on the left, thus calls for a massive relocation, even a public production of drugs.
As for the pharmaceutical sector, it assures us of its good will in terms of relocation, but points to the heavier weight of regulations in Europe. He also considers that the French public health system is hardly an incentive by imposing low selling prices.