Germany battles dramatic drug shortage – DW – 12/20/2022

Every day, Berlin pharmacist Fatih Kaynak checks the central computer database for drug availability, only to see that hundreds of drugs are still out of stock.

“We are short of antibiotics, pain relievers, but also blood pressure reducers and medicines for cancer, stomach and heart,” Kaynak said, as he sifted through a long list of drugs that are not available. “It is especially difficult for us to provide children.”

Since it is difficult for them to swallow the tablets, babies are usually given a liquid medicine. Sweet-tasting pain relievers and fever-reducing medicines containing acetaminophen or ibuprofen are also in high demand in this age group. More than 10 million packs are sold in Germany every year, but now the shelves of the Kaynak pharmacy are almost empty. There are also supply problems for penicillin and liquid antibiotics.

“If I want 50 packets of a scarce drug, I might actually get only five,” Kaynak said.

Germany’s children’s room is overwhelmed

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Desperate parents in Germany have been talking on social media for months. Tips for alternative home remedies are highly sought after. But often the only option is a trip to overwhelmed hospital emergency rooms.

Now the head of the medical association, Klaus Reinhardt, has made an unusual suggestion: those who are healthy should give whatever medicine they have at home to the sick in the neighborhood. “We need something like flea markets for medicine,” Reinhardt told Berlin’s daily mirror diary this week. Such markets could also include drugs that are months past their expiration dates, he added.

Thomas Benkert, president of the Federal Chamber of Pharmacists, is horrified by the idea. “Medications belong in pharmacies, not flea markets, and certainly not expired,” he said in a statement.

With prices rising, pharmacists look for alternatives

Pharmacies in Germany are often able to produce drugs themselves, filling between 12 and 14 million prescriptions each year, although that is only a small number compared to the roughly 1.3 billion drug packs sold in 2021.

Now, many pharmacies have started mixing anti-fever juice for children again, but with the cost of ingredients and staff, the price per bottle is several times higher than that of the standard medicine. “But what does the price matter when a child has a high fever?” Kaynak said.

It is the current price of medicines that has put Germany in this precarious position. For the pharmaceutical industry, production in Germany and Europe is often simply not worth it. For example, health insurers pay companies €1.36 ($1.44) for a bottle of liquid acetaminophen, an amount that hasn’t increased in the past decade despite the price of the active ingredient, acetaminophen. , is up 70% this year alone.

Photo of Kaynak's computer screen where everything on the list is marked as unavailable
In the general database, everything marked with a purple circle is out of stock in Germany.Image: Sabine Kinkartz/DW

“Rapidly rising prices for production and active ingredients make the production of medicines such as paracetamol juices a loss-making business,” said Andreas Burkhardt, general manager of the pharmaceutical company Teva. “No company can sustain that long term.”

Teva, with its pharmaceutical brand Ratiopharm, is the last major supplier of liquid paracetamol in Germany; just 12 years ago, there were still 11 providers. After another manufacturer stopped production in May this year, Ratiopharm now has to cover 90% of the demand. That’s not feasible, the manufacturer said.

The Federal Institute for Drugs and Medical Devices recently noted that everything has been bought. “Product availability has decreased markedly. At the same time, the sharp increase in purchases has caused a regional imbalance and stockpiling,” the institute wrote in a press release.

“Medications as simple as a fever-reducing fluid are often no longer available,” said Thomas Fischbach, director of the Professional Association of Pediatricians and Adolescent Physicians. “There are very few suppliers of such remedies because fixed price regulation in our country has led to a migration of production to low-wage countries like India and China.” There, he points out, there have also been supply chain problems, which in turn lead to supply bottlenecks.

Paracetamol packets are seen on a shelf
One company supplies Germany’s entire supply of liquid paracetamolImage: Jeff J Mitchell/Getty Images

Calls to produce more drugs in Germany

The problem is not new: in early 2022, Germany experienced a dramatic shortage of tamoxifen, a drug used to treat breast cancer patients. There is no substitute for this drug and seriously ill patients need a regular supply. Here, too, there was a sharp supply bottleneck because manufacturers had withdrawn from production, citing cost pressure.

In February, the Federal Institute for Drugs and Medical Devices intervened and ordered that, due to the emergency, alternative drugs containing tamoxifen can now be imported from abroad and sold without German approval. Still, tamoxifen remains one of the scarce drugs.

Opposition doctors and politicians are now calling for immediate action by the German government, and experts are calling for the government to produce vital drugs in Germany. It is time to rethink, they said, and production would have to be moved from Asia.

German Health Minister Karl Lauterbach responded by promising to invest more in the procurement and production of medicines for children.

This article was originally written in German.

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