When asked what drugs are out of stock in her pharmacy, Kim Burbot, a pharmacist in Vanves, south of Paris, rolls her eyes. Then, presents a table listing around fifty products: paracetamol, cortisone, antibiotics, anesthetics, anti-inflammatories, etc. In 2022, the National Medicines Safety Agency (ANSM) received more than 3,000 reports of risks of stock shortages . That is double the figures for 2019.
The public authorities are trying to stem a crisis that they hope will be temporary. For example, the government announced on January 4 the suspension of the online sale of paracetamol until the end of the month, in order to limit tensions over supply. This active ingredient, the substance that acts against the disease, is the most prescribed in France and serves as the basis for Doliprane or Dafalgan.
Pharmacies overwhelmed this winter
This winter, the situation worsened in France. Without confinement and with fewer barrier gestures, the country is undergoing a triple epidemic of influenza, Covid-19 and bronchiolitis. And the laboratories have not planned sufficient stocks of drugs to meet a greater demand than in other years.
These difficulties do not only concern paracetamol. Medicines for children are particularly affected: “In winter, they are the ones who need medicine the most and all the doctors prescribe the same thing for them”found Kim Burbot.
In the same street, another pharmacist regrets: “As soon as people hear about drug shortages, they go to pharmacies to buy them to stock up. » Faced with this complicated health situation, the ANSM advises pharmacies not to sell more than two boxes of paracetamol per patient. These can also deliver antibiotics individually, depending on the quantity and duration of treatment. Recently, the ANSM authorized certain pharmacies to manufacture an antibiotic, amoxicillin, themselves.
Will these various recommendations be sufficient to resolve the current crisis? “it will not work, it is a deeper problem”sighs the Vanvéen pharmacist.
Relocations pointed out
Globalization has weakened the drug economy by nature complex. Production is broken down into three stages: the manufacture of the active ingredient, that of the drug, then its packaging (boxing). The slightest hazard can disrupt production. It must also adjust to world demand which is only increasing. And building new production units is complex.
The production of old molecules, such as paracetamol or amoxicillin, has been delocalized. “When patents fell into the public domain, their price fell and European groups abandoned their production, which had become unprofitable”explains Nathalie Coutinet, drug economist.
Result: 80% of active ingredients are manufactured in India and China, according to the European Medicines Agency. A report from the National Assembly dated June 11, 2020 completes: “The concentration of supply is such that there are only two or three suppliers in Asia for many molecules. »
This situation complicates drug supplies, especially since the Covid-19 pandemic. In its decree, the French government points to the worsening health situation in China, where the lifting of restrictions is leading to an increase in contamination and a rush on paracetamol-based drugs. “China reserves its production for its market and reduces its exports to France”explains Nathalie Coutinet.
Prices not always attractive
The health crisis having brought to light the question of health sovereignty, the public authorities have promised to relocate the production of active ingredients in Europe. But the path is complex. Vincent Touraille, president of the Syndicate of fine chemicals and biotech industries (Sicos), confirms this: “In Asia, some players do not respect the environmental standards applied in Europe, so they are more competitive. » For him, it would be interesting to include the source of the active ingredient on the medicine boxes. “The customer might be better able to pay more for a medicine made in Europe”, he says.
In France, drug prices and reimbursement rates are set by negotiation between laboratories and the public authorities. Étienne Nouguez, member of the Center for the Sociology of Organizations at Sciences Po Paris, notes contradictions in government policy: “He wants both France to be at the forefront of innovation and doctors to prescribe low-cost generic drugs. » The social security budget provides 800 million euros in lower drug prices in 2023.
“One solution could be for the state to take into account the value of molecules and increase their price to send signals to companies”, underlines Thomas Borel, scientific director of the professional union Les entreprises du medicament (Leem). This is what Germany has done, for example, which has just announced a 50% price increase on certain drugs. In any case, one thing is certain, for Étienne Nouguez, if France is to strive for health independence, “we will have to accept to pay the price ».
Towards a relocation
On June 16, 2020, in the midst of the covid crisis, Emmanuel Macron announced a “recovery” plan during a trip to a Sanofi site in Marcy-l’Etoile (Rhône). One of the spearheads is the construction of a paracetamol factory in Roussillon, in Isère, by the Seqens group. Through France Relaunch, the State finances this project to the tune of 30 to 40%. The site must produce 10,000 tonnes of paracetamol per year to supply the laboratories. However, the project is stalling: scheduled for 2023, it has been delayed for a year. Sales will not begin until late 2025.
“Developing a new production process took time” underlines Gildas Barreyre, general secretary of Seqens. A year of research and development, a year and a half of creation of the production process, two years of construction, nine months of qualification managed by the laboratories and the ANMS. And you have to meet very strict European environmental standards. “The goal was not to reproduce the same thing as in China but rather to adapt to our times”, develops Gildas Barreyre. Good news for the relocation, Seqens is developing other factory projects such as the anti-cancer and anti-viral plant in Aramon, France.
France has another major manufacturer of active ingredients, Euroapi, which has largely taken its independence from Sanofi, in order to also sell its products to competitors of the number one tricolor in the pharmacy. But there will still be a lot to do before Europe regains some sovereignty in the production of medicines.