Paris (AFP)

Objects of a meeting in Matignon Thursday, drug shortages affect all categories, including cancer or anti-infectious. How can these essential products fail? Overview of the main explanatory factors.

A relocated production

Experts in the sector agree to point the finger at the relocation of production, the industry calling on subcontractors to lower costs. Nearly 40% of medicines marketed in the European Union come from countries outside the EU.

As for the active ingredients, the molecules necessary for the manufacture of the drug, they are massively produced in Asia. Thus, 80% of active substances used for medicines in the EU come from third countries, India and China alone concentrating 60% of sites, recalls a report of the Senate dedicated to the issue in 2018.

"The production line is cut, and the stages are produced in different places," says Nathalie Coutinet, a specialist economist in the health sector, interviewed by AFP.

"As everyone works at a tight pace, and the production sites are spread around the world, it only takes a delay somewhere and the whole chain is affected," Coutinet adds. In case of failure of a supplier of active substances, the domino effect causes cascading breaks.

Increasing demand and concentration of the sector

Global demand for medicines has risen sharply, with an increase of about 6% per year, supported by the needs of emerging countries, the "pharmerging", like China.

"There are markets that are exploding, so there is a very strong tension on supplies," commented AFP Philippe Lamoureux, CEO of Leem, the professional organization of drug companies.

Thus, the launch of a massive vaccination campaign in a country like China, difficult to anticipate by industrialists, can lead to supply tensions, especially since, at the same time, the sector is highly concentrated and only one or two producers in the world remain for one or another treatment.

"We can increase production but demand is growing faster than supply," said Professor Mathieu Molimard, of the French society of pharmacology and therapeutics, interviewed by AFP. Since, moreover, manufacturing processes are highly controlled, factories suffer from a lack of responsiveness in the event of increased demand. Here too, the domino effect is fast.

The question of prices

The most expensive drugs are very rarely affected by shortages. There are "economic reasons", commented Mr. Lamoureux, Leem. In some cases, "prices have become so low that they are lower than the cost of production, and so we can no longer supply the market," he continues.

"In order to encourage innovation, very high prices are awarded to new and innovative medicines and, in return, lower prices for older medicines are lowered," explains Coutinet.

"An industrialist prefers to build a plant to produce a drug to 10,000 euros that a drug to 2 euros per box," said Mr. Molimard.

A laboratory can thus decide to stop the production of a drug considered not profitable enough. In this case, even if the authorities had to be warned well in advance, tensions in the supply may appear. More broadly, pricing mechanisms are to be taken into account and can serve France, where drug prices are generally lower than in neighboring countries.

Thus, wholesale distributors, called "short-liners", have recently been sanctioned by the authorities, because supplying them in France and then selling the drugs in countries with higher tariffs.

© 2019 AFP