Shortage of medicines: “The situation is catastrophic” | EUROtoday

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ua worsening disaster. In 2023, the difficulties in supplying medicines have worsened additional. The Medicines Safety Agency (ANSM) indicated, on the finish of January 2024, that it had recorded 4,925 stories of inventory shortages and dangers of inventory shortages over the earlier 12 months, a rise of 30.9% in comparison with 2022, and +128% in comparison with 2021.

This downside, recognized to everybody for greater than ten years, has been growing since 2018, inflicting concern and anger amongst well being professionals. “The situation today is catastrophic,” confides to Point Pierre Olivier Variot, pharmacist in Plombières-lès-Dijon (Côte-d'Or) and president of the Union of Community Pharmacists' Unions (Uspo).

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Already in 2019, a bunch of hospital docs wrote an article in The Sunday Journal asking the federal government for a paradigm shift. “We must relocate production to Europe,” they declared. In 2018, based on the ANSM, 868 stories of tensions or provide disruptions have been recorded.

Then, with Covid-19, the state of affairs deteriorated. “The current situation is not only aberrant for the finances of our healthcare system, but it is also ultimately dangerous for patients,” warned in Point infectious illness specialists and pharmacists from the National Network to Combat Antibiotic Resistance.

Multifactorial causes

“According to a study we commissioned, pharmacists now spend an average of twelve hours per week dealing with shortages, between searching for boxes, calling laboratories, wholesalers, colleagues… A third of wasted time », explains Pierre Olivier Variot.

The causes of this problem are numerous: “difficulties occurring during the manufacture of raw materials or finished products, quality defects in medicines, insufficient production capacity, fragmentation of manufacturing stages…” lists the ANSM.
READ ALSO The authorities is growing the value of medicines… to keep away from shortages

“The causes of disruptions are multiple, induced by a globalization of production which now relies on a very small number of raw material factories located in Asia, a rapidly growing demand causing a tense market, and a globalization of the market with a disparity in prices and therefore sales profits depending on the country, France being a country where the price of medicines is imposed and relatively low”, explained to Point infectious disease specialists and pharmacists from the National Network to Combat Antibiotic Resistance.

For Pierre Olivier Variot, two categories of stock shortages exist. There are the “explainables”, when manufacturing doesn’t sustain with demand throughout an epidemic, when batches of medicines don’t go qc. “But there are other ruptures that we cannot explain: we have shortages of medicines even though they are stored by manufacturers…”

“Why don’t they release the drugs? »

The recent shortage of amoxicillin in its pediatric version is the perfect example, according to the trade unionist. While 80% of the active ingredients of the antibiotic are manufactured in India and China, “thanks to the enormous work of the ANSM, we realized that manufacturers had between three and five months of stocks of amoxicillin [sous forme buvable 500 mg/5 ml, NDLR] but that there were between zero and three days of stocks at wholesalers and pharmacies. »

A grotesque situation which had challenged the pharmacist and his colleagues. “This situation is incomprehensible,” denounced, at the time, on France Info, the president of the Federation of Pharmaceutical Unions of France, Philippe Besset, before adding: “We have been questioning manufacturers for months, but we have no answer. »

For Pierre Olivier Variot, there is something fishy going on. “It's like asking you to stock up on peas in anticipation of a famine, but when you need them, you just look at them. We are in the same situation but with antibiotics. » Pierre Olivier Variot thus points to a lack of transparency. “Why don’t they release the drugs? »

Last November, a “charter of commitment for equitable patient access to medicines subject to supply tensions” was signed by all players in the pharmaceutical chain to prevent inequalities in the distribution of medicines and thus some shortages.

The National Assembly will examine, Thursday, February 29, a bill from the Socialist Party aimed at combating these shortages. The group proposes in particular, in article 1erto allow the ANSM, when stock levels are “incompatible with the appropriate and continuous supply of the national market”, “ [d’]authorize the marketing authorization holder or the pharmaceutical company operating a medicinal product to constitute a safety stock of a lower level”. “We must force manufacturers to release stocks,” adds Pierre Olivier Variot.

The prescription puzzle

All drugs are affected by these shortages even if “cardiovascular drugs, those of the nervous system, anti-infectives and anti-cancer drugs are more particularly represented”, indicates the ANSM in a press release. In the winter of 2023, France was hit by a shortage of paracetamol. “It’s a big worry for patients. Some cry. Some people get angry. Then others come and tell us that they are going to take their cancer medication every other day, so their boxes will last longer. Except that their treatment is no longer effective…” explains the president of Uspo.

According to a study by the League against Cancer dating from 2019, 75% of health professionals surveyed believed that these shortages led to a loss of opportunity for patients. Worse, “45% of professionals questioned in the survey noted a deterioration in the five-year survival of their patients who are victims of shortages of drugs against cancer,” according to the League.READ ALSO Shortage of medicines: ought to we pay extra to be higher served?

Action appears to be vital. But docs denounce a prescribing headache. “We do something approximate. We must find a drug that looks similar, which does not always have the same function, not always the same side effects and which may pose a problem for the patient because it does not have the same appearance and not necessarily the same conditions. “use”, declared, in May 2023 within the Senate, the neurologist Bruno Perrouty, president of the “specialists” department of the Confederation of French Medical Unions (CSMF).

“Relocate and avoid departures”

Pierre Olivier Variot, for his half, pleads for the institution of equivalence tables. “The doctor prescribes medication A, and if we no longer have it, we replace it with medication B. Afterwards, I am not saying that it is the best solution: the patient who is used to taking his treatment might be a little suspicious and he would be right. »

Ministers Catherine Vautrin and Roland Lescure recently announced a new anti-shortage plan. They particularly insisted on their desire to relocate the production of medicines and to open new manufacturing lines in the coming months. “We must relocate but also avoid departures. From now on, if a manufacturer wants to stop an important drug, it will have to do everything to find a buyer, declared to the Parisian Roland Lescure. What we did for paracetamol, we will do for amoxicillin and other essential drugs. »

Another announcement: doctors will now be encouraged to avoid prescribing treatments in shortage. “But today, finally, what is the government proposing? asks Pierre Olivier Variot. I rather have the impression that the central problem is: “What do we do in the event of a shortage?” It needs to be: “What are we doing so that there is no longer a shortage.” »