Is there a risk of a supply gap?
This is what the medication shortage means for you
Updated 10/11/2024 – 9:51 a.mReading time: 3 min.
Pharmacies are sounding the alarm: Hundreds of medicines are currently not available in Germany. But what does this mean for patients?
Saline solution, painkillers, fever reducers: There are currently delivery problems with almost 500 medications. This emerges from the database of the Federal Institute for Drugs and Medical Devices (BfArM), in which manufacturers enter supply bottlenecks for supply-critical drugs.
But does that mean you now have to go without medication?
A delivery bottleneck is defined as an interruption to a delivery to the usual extent that is expected to last more than two weeks. A significantly increased demand that cannot be adequately met can also mean a delivery bottleneck.
No, says Ulrike Holzgrabe, senior professor of pharmaceutical and medicinal chemistry at the Julius Maximilian University of Würzburg. It should be noted that not every bottleneck means a gap in supply, she explains. “If certain blood pressure medications are difficult to obtain, it’s not a supply problem.” It is easily possible to switch to other medicines.
There is only a gap in supply if this option is missing. “Bottlenecks in antibiotics, for example, are highly problematic,” explained the senior professor. Switching to another antibiotic is always only the second best treatment. Salbutamol for the treatment of asthma or atomoxetine for ADHD are also difficult to replace. “Both medicines have recently been affected by shortages.”
Also important for assessing the current bottlenecks: The number of reports has hardly changed since last year, said David Francas from Worms University. In June 2023 there were around 480 bottlenecks. On a positive note, the steady increase in delivery bottlenecks since 2017 currently appears to have slowed down. Francas also emphasized that not every bottleneck is equally important for patients.
Last year, Federal Health Minister Karl Lauterbach (SPD) introduced the Act to Combat Drug Supply Bottlenecks and Improve Care (ALBVVG) in order to systematically combat bottlenecks and improve security of supply.
It was not expected from the outset that anything would change quickly afterwards, said Holzgrabe. “Basically, the problems of delivery bottlenecks are known and sufficiently researched: In Germany we have pushed prices so low with discounts and fixed amounts that the German market is simply not attractive for many manufacturers.”
Francas is also convinced that the prices of many medicines that are important for widespread supply have been turned too high. “The connection between low prices and poorer drug availability has now also been empirically proven.”
In addition, more and more monopolies are emerging in which a drug is only produced by a few manufacturers, added Holzgrabe. “If a manufacturer fails for whatever reason, and that could simply be natural disasters close to the factory, we have a problem.”
One reason for little production in this country is very strict – and therefore discouraging – guidelines for manufacturers. “In Germany, for example, you as a manufacturer are only allowed to produce one antibiotic in a factory, not several. That’s different in China.” However, impurities in antibiotics can also be seen in such drugs coming from China.
“But I’m sure there is a middle ground,” the professor is convinced. In any case, it is very important to move away from dependence on producers in Asia. “The current system is very entrenched. However, the EU has taken a first step forward and identified medicines that should ideally be produced in Europe.”
It is important not to work with the watering can principle straight away, emphasized Francas. It is also “an inconvenient truth” that corresponding measures are associated with significant costs.
Lauterbach wants to bridge the current supply bottlenecks for saline solution through imports. A spokesman said he would temporarily create the conditions for the import of saline solutions as medicine.
Saline solution is important, among other things, for infusions, for making medications and for operations. Therefore, the North Rhine-Westphalia Hospital Association (KGNW) warned at the beginning of the week that, in the worst case scenario, operations would have to be postponed. Read more about this here.
“I find it strange that the issue is coming to the fore now, because we could already see in the spring that there could be problems with saline solutions, for example,” said Holzgrabe. Braun and Fresenius, the two key manufacturers, had already reported difficulties back then. When it comes to saline solutions, there is actually currently a supply bottleneck.
The causes are probably complex, as Francas, professor of data and supply chain analysis, explained. There was damage to a factory in the USA due to Hurricane Helene, and before that there were bottlenecks at manufacturers due to problems with glass bottles. Because of global networking, there will quickly be global effects.