Empty drawers in pharmacies and drugs that are chronically lacking are nothing new. For several years, France has regularly faced supply tensions, even real shortages. A phenomenon which has further amplified under the effect of the health crisis, then the triple viral epidemic of Covid-19, influenza and bronchiolitis this winter and inflation.
The situation raises questions regarding the security of French men and women’s access to the medicines and treatments they need. How can these risks of shortages be permanently and effectively eliminated? This is what the government is trying to tackle, which has just launched a drug steering committee providing in particular for price increases and a strengthening of France’s industrial sovereignty.
Price increases implemented
First measure announced by the Ministers of Health and Industry: a moratorium on price reductions for generics considered strategic from an industrial and health point of view. While France is experiencing a shortage this winter of antibiotics widely prescribed in this epidemic period, in particular the pediatric form of amoxicillin, the government has announced that it will authorize price increases for certain essential generics, in order to encourage manufacturers to continue production. Price increases granted “in return for commitments by manufacturers to secure supply to the French market”, they indicated.
“It was essential to take strong measures (…) to protect the price and revalue the essential “old” drugs, rejoices Thierry Hulot, president of the Read, the syndicate of pharmaceutical companies. More than ever, it is urgent to review the budgetary envelope for drugs. “The union points to” the industrial cost of these drugs which have continued to increase over the years, with a notable acceleration in 2022 due to galloping inflation, while their purchase price by the Insurance disease has continued to decline, with the consequence of accentuating price differentials with our European neighbours. »
The decision to raise prices was unsurprisingly welcomed by the drug industry, but sparked the ire of the Observatory of Transparency in medicines policies (OTMeds), which denounces “the amateurism of the executive”. And who deplores the fact that “essential work on drug shortages, on the concentration of pharmaceutical production in Asia, on access to health products compromised by the dynamics of price increases” is ignored, believing that “the debate bogged down in an increasingly problematic complacency vis-à-vis public institutions, which are nevertheless in charge of finding solutions to guarantee our health security”.
Relocations to strengthen sovereignty
It is true that to produce less expensively, the pharmaceutical industry has in recent years largely delocalized the manufacture of its drugs. China and India have thus become the largest manufacturers of drugs and active ingredients in the world. Behemoths on which France has become dependent to ensure its supplies, which can be in tension or even broken, especially when the producing countries decide, in favor of the health crisis, to reduce their exports to treat their population, or to sell to countries ready to offer a better price.
A problem that the Head of State Emmanuel Macron tackled in the summer of 2020, then promising an envelope of 15 billion euros for innovation and pharmaceutical relocations. “The French vision has evolved a lot and today, the importance of relocating the pharmaceutical industry is unanimous, observes Professor Isabelle Durand-Zaleski, professor of public health and head of service at the AP-HP. This is obviously one of the levers to be activated to effectively combat drug shortages, which also has the advantage of reducing the carbon footprint of health products. »
But are relocations economically viable to constitute a lasting solution to shortages? “To avoid these ruptures which are multiplying, we have to go through it and be ready to pay more for the drugs, answers Professor Durand-Zaleski. But these higher production costs might be mitigated by relocating generics first. But also by continuing the policy of delisting drugs that have an insufficient medical service. »
Prevention and education for better drug consumption
For the public health specialist, it is a question of “not thinking only in terms of costs, but in terms of overall use: a single drug may be more expensive, but there is a whole reflection to be carried out on its conditioning, its just prescription and its waste”. Because in fact, “on a sociological level, numerous studies have shown that the French were among the biggest consumers of drugs in the world behind the United States, and among the biggest in Europe”, underlines Jocelyn Raude, teacher -researcher in social psychology of health and infectious diseases at the School of Advanced Studies in Public Health (EHESP).
Among the medicines in tension are antibiotics, for which demand has exploded this winter. “Legitimately, the needs have increased with the viral epidemics, admits Jocelyn Raude. But this is one of the drugs for which educational work must be continued: there is still a plateau effect today, and doctors indicate that they have strong demands from their patients for antibiotics, especially the oldest , for which effective treatment requires antibiotics. But things are changing, and the younger ones have absorbed the information on the need to have a reasoned consumption of antibiotics. »
Old reflexes which are “the direct effect of the” all curative “, estimates Jocelyn Raude. The French health system is built on the management of diseases, in particular through pharmacological treatment. On the other hand, the culture of prevention and behavioral medicine is very underdeveloped in France. We are lagging far behind alternatives to drugs, whose effectiveness – often superior to drugs – has been demonstrated in terms of both mental and physical health. The problem in France is that these complementary approaches are taken over by alternative medicine, sometimes falling into quackery, and this is harmful. »
However, acting upstream, promoting physical activity, a balanced diet and fighting once morest addictions are all levers for maintaining a healthy population, which therefore has less need for medication. “This is what the government is trying to do, recognizes Jocelyn Raude. We are now talking regarding the Ministry of Health and Prevention. It is now a question of getting out of the symbolic and the curative and pharmacocentric vision which is difficult to change. »
