The shortage of antibiotics and other drugs has caused governments across the European Union severe headaches as citizens grow increasingly angry as they deal with the consequences of not being able to access essential medications.
Painkillers and drugs against fever (anything containing Paracetamol or Ibuprofen), as well as antibiotics, are in short supply in pharmacies, and children’s medicines are particularly scarce.
According to the EU generics boss Adrian van den Hoven, the antibiotics market is expected to stabilise in about a month as long as the rate of infections declines.
However, the continent is currently plagued by a combination of influenza, COVID-19, and respiratory syncytial virus, leading to a surge in hospitalisations and the demand for medicines. With some three months of winter and flu season left, there are concerns that supply chains may be stretched to breaking point.
EURACTIV’s network looked at the current situation in EU capitals as well as examined the reasons why the EU market reached such a deadlock.
In an interview with EURACTIV, van den Hoven from Medicines for Europe said the situation may normalise “in about one month, as long as the rate of infections declines.”
However, the problem is that following the pandemic, infection seasons are not as predictable as before COVID.
“In the post-COVID period, we don’t know how high this infection rate will go. So, if the infection rate continues to go very high, it could last longer than a month,” he said.
Van den Hoven explained that the industry is now adapting to produce more antibiotics by increasing the number of people working in the factories. On the positive side, he said a lot of this medicine is still produced in Europe.
“Some of it is produced in India, but a lot of it is still produced here in Europe, in Austria, in France or the UK”, he noted.
Referring particularly to the shortage of antibiotics, he said during the pandemic, there was a dramatic reduction of consumption – because people were working from home and outside, they were wearing face masks – and therefore, the industry adapted the production to the lower demand.
But the surge of infectious diseases in 2022 came earlier than expected.
“It was expected that there would be a surge in infections, but more towards the Christmas period or after. And instead, it came very early, already in October and November. And so, there was a huge surge in demand for brand antibiotic medicines”, he said.
Van den Hoven also noted that, at least in the case of Europe and the US, there had been a huge surge in demand for children’s drugs and soluble powders.
“This is a particular big problem because, of course, you produce less medicine for children than you do for adults because there are fewer children”, he said.
Although there is a roadmap for antibiotics, for other drugs, the situation remains critical as even the basics, like paper and cardboard, are missing.
This could be partly explained due to the Russia-Ukraine war, as both countries are major paper producers.
He said often, when we have a shortage in Europe, we move supplies around from one country to another. But that requires you to tear the box off and put a new box on it with the new language.
“That’s a real problem today because it wastes a lot of paper and cardboard that we currently don’t have […] So we’re asking for flexibility regarding this re-boxing; if we can do like during COVID, you could send boxes just with a sticker to a different country”.
Another reminder for EU autonomy
Critics suggest that the drugs’ deadlock reminded Europe again of the need to become autonomous in this field.
An EU official told EURACTIV that for the short term, the Commission would try to step in and help factories increase the production of drugs, while in the medium term, the presentation of the EU Pharmaceutical Strategy will be sped up.
The official made it clear, though, that the order of medicines remains an exclusive national competence.
However, the next months could be particularly challenging for some EU member states, especially considering predicted new COVID waves.
In Germany, SPD health minister Karl Lauterbach announced in December that the government would introduce significant changes to medicines pricing rules. Specifically, health insurance should pay more for the drugs in question to make sure producing/supplying them is economically viable.
The government also plans on stockpiling key drugs in the future. Yet, Lauterbach also said that drugs produced in the EU should be prioritised in many public procurements to boost European sovereignty and fight concentration of production in third countries.
In Austria, more than 540 drugs are currently not available, or availability is limited.
To tackle the problem, both the president of the Federal Association of Pharmaceutical Wholesalers (PHARGO), Andreas Windischbauer, and the Social Democrats’ (in opposition) health spokesperson, Philip Kucher, proposed establishing a “national crisis stockpile” of key drugs.
Kucher also called to boost production in Austria and the EU, for example, through a “Made in Austria fund” worth €3 billion to support domestic production. “The availability of life-saving drugs is too important to leave it up to chance or China,” he said.
In France, health minister François Braun said regarding amoxicillin, the most prescribed antibiotic in France, it would take “two months to have our stocks replenished”. On the other hand, he said paracetamol would normalise “very quickly”.
“France is relocating pharmaceutical industries to produce drugs. This is an absolute necessity,” government spokesman Olivier Véran told EURACTIV France at a press conference.
“One of the lessons of the crisis is that Europe cannot remain 95% dependent on a few Asian countries in terms of access to medicines,” he said.
Unlike France, Belgium has a sufficient stock of Amoxicillin. In the event of a shortage, Belgian pharmacies equipped with a laboratory could be asked to produce paediatric Amoxicillin themselves.
“There is no shortage at this stage in the sector of novel and innovative treatments, but given the current situation in Ukraine and China, we remain on the alert,” said David Gering, spokesperson for the General Association of the Pharmaceutical Industry.
In Greece, the government decided to switch to the domestic production of generics as 162 drugs were missing from the market. The health ministry said things would normalise at the end of January, but surveys show that citizens prefer “old branded” drugs over generics.
In Italy, the Medicines Agency (AIFA) reported a shortage of more than 3,000 drugs, 554 of which are in short supply.
Domenico Di Giorgio, director of Aifa, told Il Manifesto that in the case of a real crisis, “action can be taken on a continental level with joint purchases, as was the case for the anti-Covid vaccines”.
In Portugal, the National Drug Authority is pushing for the creation of “a list of critical medicines” that will allow it to act in different ways depending on the situation.
In Bulgaria, over 300 medicines, including some antibiotics, are missing from pharmacies, the chairman of the Association of Pharmacy Owners, Nikolay Kostov, said.
According to him, the demand for antibiotics in December doubled compared to the same month in 2021.
He added that the distributors did not plan twice as many quantities, and it is already too late to make contracts for new supplies because they would arrive in 6-8 months.
In Slovenia, the supply of 200 drugs is disrupted, though many have generic equivalents.
One major problem probably unique to Slovenia is that there is a regulation effectively requiring pharmacy chains to jointly procure drugs to keep prices low. However, within the last year, three such public contracts have been thrown out by the national regulator in charge of public contracting. Pharmacies have therefore had to break the public contracting law just to keep supplies running.
Sweden faces similar drugs’ shortages, but one patient group that has been hit hard is people with epilepsy in Sweden, where several different types of epilepsy medicines are in shortage, according to Swedish radio.
Yet, less common drugs used to cure cancers and rheumatic diseases happen to suffer shortage, posing significant risks for patients who do not receive their prescribed medication. This can lead to a worsening of the rheumatic disease, which can have other serious consequences for the patient, such as increasing disability.
In the Czech Republic, some medicines may be missing until spring admitted to the Chamber of Pharmacists. The main reason for the shortage is the interruption of the supply of medicines to the Czech Republic and neighbouring countries from China and the increased consumption of medicines due to high morbidity.
Antibiotics are now the most scarce in pharmacies. According to the ministry, there is no risk that the patient will not get any antibiotics; alternatives are always available. However, due to shortages of basic drugs such as penicillin, doctors sometimes have to prescribe broad-spectrum antibiotics instead of narrow-spectrum antibiotics targeting specific types of bacteria. This approach has its risks.
In Poland, the shortage is particularly noticeable with analgesic and antipyretic drugs, Mikołaj Konstanty, chair of the Silesian Pharmacists Chamber, told Polish Press Agency (PAP). “We also lack antibiotics, especially in paediatric doses, neurological or diabetic drugs”.
He added that there is also a shortage of morphine or drugs used to treat cancer. “We don’t have much influence on this. The production of drugs was moved to Asia many years ago, which now limits the availability,” said Konstanty.
In Slovakia, patients are experiencing shortages of common over-the-counter medicines, including suppositories for children for fever and pain and tablets for sore throats.
The Ministry of Health addresses the situation with some short-term measures. These include substituting a prescribed medicinal product with another medicinal product with the same active substance when dispensed in a pharmacy per the relevant regulations.
In addition, Slovakia favours the import of foreign language packages of medicines.
(Sarantis Michalopoulos | EURACTIV.com – Anne-Sophie Gayet, Arthur Riffaud, Julia Dahm, Federica Pascale, Krasen Nikolov, Sebastijan R. Maček, Charles Szumski, Clara Bauer-Babef, Ondřej Plevák, Aleksandra Krzysztoszek, Susana Oliveira, Michal Hudec)