2023-10-27 04:01:18
Tensions in the global drug market have not disappeared. To deal with this, the government and the National Medicines Safety Agency have taken several decisions, but pharmacists remain worried.
Will France once once more experience a shortage of medicines equivalent to that of last year? During the winter of 2022-2023, certain products, such as amoxicillin and paracetamol, experienced supply problems of varying lengths. These tensions proved particularly problematic at the end of 2022 and the beginning of 2023 in the context of a triple epidemic of Covid-19, flu and bronchiolitis.
At the origin of the problem: the mismatch between a limited number of producers and growing global demand. Pharmaceutical manufacturers have also relocated their production to India and China, where costs are lower, making the rest of the world dependent on these countries. The war in Ukraine has also disrupted the drug supply chain, with kyiv producing a number of components needed for drug packaging.
While fall is well underway, pharmacists are once once more concerned. “We know that, during the winter, our requests will concentrate on the same class of drugs, in particular paracetamol and antibiotics, which are molecules for which we are already experiencing tensions”details Bruno Maleine, the representative of pharmacies within the National Order of Pharmacists. “We can clearly see that history has a strong chance of repeating itself”also believes Gabrielle Gross, president of the Union of Pharmacists of Ain, in Progress. Grégory Tempremant, president of the Regional Union of health professionals and community pharmacists, even believes in The voice of the Norththat the situation risks being “pire” than last year.
The ministry recognizes “disparities” according to pharmacies
Is their concern legitimate? More than 3,700 medicines experienced shortages or supply tensions in 2022 in France and the figure is likely to increase in 2023, with 3,500 declarations of shortage or risk of shortage at the end of August, according to the National Medicines Safety Agency (ANSM). As of October 18, pharmacies were already in tight supply of several major winter medications, according to an ANSM census. Stocks of certain forms of amoxicillin, paracetamol, prednisolone or fluticasone were thus less than seven days, or even three days, compared to a stock of more than seven days in a situation considered normal.
The health authorities nevertheless want to be reassuring. “If we focus on the molecules that we use during winter pathologies, (…) we are in situations where the stocks are there, at the industrial level”, underlined Christelle Ratignier-Carbonneil, general director of the ANSM, on October 4 on franceinfo. According to the census carried out by the ANSM on October 18, salbutamol was in fact the only winter drug for which manufacturers’ stocks were below normal. On the other hand, Christelle Ratignier-Carbonneil recognized “disparities in access at the pharmacy level” on certain molecules, in particular on amoxicillin, the most common antibiotic. Same story with Aurélien Rousseau, Minister of Health, who pointed out to France Inter the “over-stocks” made by some “grosses pharmacies”.
Really “adapted” measures to respond to the situation?
To deal with this problem, the Minister of Health announced “the decision to give back to those who distribute the responsibility that all pharmacies, including the smallest, have access to these stocks”. At the request of the government, the ANSM also established a winter epidemic preparation plan, unveiled at the beginning of October. Depending on the evolution of epidemiological data, supply data and feedback from caregivers in the field, the health agency may have to import medicines, limit exports abroad of molecules produced in France, or even authorize compounded preparations – medicines prepared to measure in pharmacies for the specific needs of a patient. This measure, which had already been authorized last winter, will be extended this year to hospital pharmacies if necessary, announced Aurélien Rousseau in The echoes.
In August, the minister also decided to increase the price of amoxicillin by 10%, once morest a guarantee from manufacturers of having sufficient stocks. Then in September, the executive also announced its intention to make the sale of certain antibiotics individually compulsory, to avoid wasting doses among individuals. Finally, Aurélien Rousseau recalled on France Inter that the government was tackling the problems of shortages in “relocating the production of 25 strategic drugs to France” and working towards the best availability of “450 essential medicines”.
The European Union has also taken up the subject. At the end of October, the Commission unveiled its plan to remedy the shortages, announcing in particular the launch of a European voluntary solidarity mechanism for medicines, from October. Among the other measures unveiled, we also find the authorization of regulatory exemptions from 2024, for example by extending the shelf life of certain molecules or the acquisition of joint stocks with the EU for next winter.
“It is difficult to know if these measures will be sufficient to get through the winter, because we do not yet have enough perspective.”
Bruno Maleine, representative of pharmacies at the National Order of Pharmacistsat franceinfo
Among the avenues still to be explored, he believes, like many observers, that it “you have to wonder regarding profitability” medicines for manufacturers… that is to say their price.
The pharmacist also points out that unit sales are not currently possible. “adapted” how medicines are designed. “There is only one leaflet in the box, and the name, dosage of the drug and batch number do not appear on the back of each tablet… Moving to single unit sales means rethinking the method distribution of the medicine since its manufacture.” As for the reindustrialization of production, “this will play out in the long term”.
Despite the measures put in place, the occurrence of major difficulties this winter will therefore depend mainly on the intensity of the epidemics. To try to limit its importance, the government launched a joint vaccination campaign once morest Covid-19 and the flu at the end of October. The executive also ordered 200,000 doses of the new preventive treatment once morest serious forms of bronchiolitis. But the vaccine has since been almost impossible to find in France. One more shortage.
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