Shortages of common older medicines are increasing. Experts say it’s in part because pharmaceutical companies are de-incentivised from producing them.
At a pharmacy in eastern Paris, there’s a long list of medicines that are currently unavailable from suppliers.
Pharmacist Pierre-Antoine Drubay says he has seen these shortages increase in the last year, estimating that on any given day, around a third of the medicines patients are seeking are out of stock.
It is affecting medicines for all pathologies, he added, from antibiotics to medicines used to treat cardiovascular disease and diabetes. When the pharmacist’s supplier outside the French capital says the medicines aren’t available, the only option left is to troubleshoot.
“Every day, we are trying to find solutions,” Drubay told Euronews Next. This can include calling the supplier, the laboratory, and other pharmacies. Sometimes, he calls the patient’s doctor to try to change the prescription.
Often, he has no information about why there is a shortage or when it will be over.
“It puts us in an awkward position with patients and doctors, it increases our workload, and the lack of transparency, that’s really the worst,” he added.
A new statement on Monday from one of France’s pharmacy unions, the USPO, called for more transparency as well, adding that drug shortages were becoming a permanent problem.
Officials are aware of the concerns, and with the prospect of a triple epidemic of COVID-19, flu, and respiratory syncytial virus (RSV) this winter, France’s medicines agency (ANSM) presented a plan last week that aims to reduce potential shortages of commonly used drugs.
But this is also a larger problem that experts say has increased over the last decade due to production and supply disruptions related to how medicines are manufactured.
Why have drug shortages increased?
Older medications are often subject to shortages because medicine prices drop once a laboratory’s original patent expires and other companies can make generics.
“There is a shortage of these older drugs because they bring in less money than the new drugs, and since the pharmaceutical companies make less money, they try to save money,” said Professor Jean-Paul Vernant, a haematologist at the Paris hospital la Pitié Salpêtrière.
Both the active ingredients and manufacturing of medicines used to be done by pharmaceutical companies in France or other European countries, but increasingly, these companies have outsourced the work.
“To save money, instead of working with laboratories that they had worked with previously [chemical laboratories that manufacture the active ingredients and subcontractors that do the manufacturing], they send that work to India and China where it’s much cheaper,” said Vernant of the situation in France.
“In India and China, wages for people working in chemical factories are extremely low and environmental standards are very poor,” he added.
Pharmaceutical companies also do not keep stocks of these older medicines that are much less profitable than the newer therapies. A small disruption during manufacturing, for instance, can lead to a shortage.
‘Tremendous impact on families’
France is not the only country struggling with medicine shortages, with EU politicians also stating that they will work to address the problem.
EU health commissioner Stella Kyriakides told MEPs last week that addressing the medicine shortages was a top political priority in Europe, adding that there was a new alert system and shortage prevention plans, as these are problems impacting multiple countries.
Meanwhile, in the US, there are concerns about shortages ranging from antibiotics to staple cancer treatments.
Dr Rohan Khazanchi, a resident in paediatrics at Boston Children’s Hospital, in the US, has studied the impact in particular of last year’s amoxicillin shortage (which impacted EU countries as well) on children’s prescriptions.
“Drug shortages, especially when they impact commonly prescribed medications like paracetamol [also known as acetaminophen] and amoxicillin, have a tremendous impact on families caring for their sick children,” he said, adding that this is particularly felt during surges of seasonal respiratory illnesses, such as COVID and flu.
It can also adversely impact treatment and waste the time of doctors and pharmacists who need to find a solution for medicines to replace those that are unavailable.
Khazanchi recently published a study with his colleague Dr Ryan Brewster analysing the impact of the shortage of amoxicillin on prescriptions for children’s ear infections.
They found that amid the 2022 to 2023 shortage in one US health system, the use of alternative medicines increased.
These alternatives “may have similar effectiveness, but carry worse side effects, are more costly, and have broader-spectrum coverage, meaning they increase the risks of antimicrobial resistance,” Brewster, who is also at Boston Children’s Hospital, told Euronews Next.
How are medicines agencies planning to deal with more possible shortages?
France’s ANSM said they may be required to implement measures to prevent shortages, including quotas, distribution changes, and imports intended for other markets to allow patients to have access to key medicines.
Health minister Aurélien Rousseau has said that there are some 450 medicines under surveillance. Earlier this year, French President Emmanuel Macron announced a plan to re-localise the production of 25 medicines to avoid shortages.
Germany also released a list of children’s medicines to monitor last month, with health minister Karl Lauterbach adding that “we are significantly better positioned than last year”. The German health ministry said they set up a high-level working group with companies and health workers.
If “panic buying is avoided,” the supply of children’s medicines will be secured, the institute said, but the larger problem is still present.
Medications of high therapeutic interest, of which there are hundreds, could be subject to a shortage at any time.
Vernant and several of his colleagues propose creating a non-profit public structure that contracts private French or European companies to organise the production and manufacturing of these medicines that are, in particular, of major therapeutic interest.
He cited the example of Civica Rx in the US, which was created as a non-profit by several hospitals to produce generic medications and address a recurrent problem of drug shortages.
Doctors in the US, meanwhile, say that governments should require the disclosure of supply issues, incentivise the production of generic antibiotics, and create opportunities for domestic production of essential medicines.
Meanwhile, Drubay says at his pharmacy in Paris, without more information about the shortages, it’s like working blindly. Sometimes the shortage only lasts a week, so the patient could have waited without it impacting their health as well.
“We didn’t have the information at the time and we sent the patient to the other side of Paris to be able to collect their medication,” he said.
But they can’t just tell patients to wait for medication when they don’t know when it will next be available.
“The patient wouldn’t come back to the pharmacy, and from a health perspective, it’s inadmissible to tell a patient that,” he added.
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