In this month of December, provider of epidemics such as the flu and Covid-19, it is "difficult" to obtain some of the most prescribed drugs in France.
“The situation has been very tense since the start of 2022,” explains Pierre-Olivier Variot, president of the Union of Community Pharmacists (USPO).
"Drug shortages have increased by 15% compared to last year, and 3,000 molecules are in supply tension. At the moment, we are particularly short of paracetamol and amoxicillin."
These two drugs are lacking in France in their pediatric form, while an epidemic of bronchiolitis is raging and amoxicillin represents 90% of antibiotic prescriptions in children.
The public medicine agency (ANSM) thus alerted to the situation in November, citing a shortage which could last until March, while a delegation of pediatric professionals was received on Friday at the Elysée.
A global problem
For the moment, reports Andréas Werner, president of the French Association of Ambulatory Pediatrics (AFPA), doctors are managing to "get by", by prescribing adult forms of antibiotics to children.
Then charge the parents to adapt the dosage to the weight and age of their offspring, following the recommendations of the pediatrician.
But the solution is not long-lasting, according to Andréas Werner: postponements of treatment risk having a domino effect and causing new shortages and the development of resistance.
The situation is far from being limited to France: according to the Pharmaceutical Grouping of the European Union (PGEU), 25 of the 27 Member States currently lack amoxicillin.
Italy, France, the United Kingdom, Spain and Portugal are particularly affected.
On the other side of the Atlantic, the United States, like Canada and Australia, are also struggling to find this antibiotic, which has been on the list of drugs in shortage since October.
In fact, 80% of the 35 countries monitored by the WHO report a shortage.
Shortages of common drugs, including paracetamol, have also been reported.
Paused exports
In question, a multitude of factors, including the epidemic recovery in China.
Faced with the explosion of contamination following the end of the “zero Covid” policy, Beijing requisitioned its factories to supply its national market.
In Shandong province, south of Beijing, an ibuprofen manufacturer has even seen its exports "paused", reports France Info.
However, explains Hubert Testard, specialist in Asia and international economic issues at Sciences Po, author of "Pandemia, the tilting of the world" (ed. de l'Aube, 2021), China is responsible for the production of majority of the raw materials needed to make amoxicillin and paracetamol.
"'Basic' drugs such as paracetamol and amoxicillin have been outsourced by Westerners to India and China for thirty years," summarizes the expert.
"These drugs are not very profitable and their production requires large investments, which has led to their relocation to China, causing a fairly strong dependency. On the other hand, China depends on the West for drugs treating complex chronic diseases ."
Extremely concentrated, the production of these "basic" drugs is thus particularly sensitive to health and geopolitical crises.
The problem dates from well before the Covid-19 crisis and is getting worse: since 2000, the number of drug shortages reported in France has multiplied by twenty.
"The unavailability of medicines is on the rise in Europe (and) shortages are a global concern", warns Ilaria Passarani, secretary general of the PGEU, in his annual report.
"Shortages of medicines are a structural problem and concern both essential medicines and medicines in very common use."
Lower production since 2020
A problematic situation, aggravated by the explosion of winter diseases, the immune defense of populations being at its lowest after two years of social distancing, and this while manufacturers have lowered their production during the pandemic.
"We are much more often sick in 2022 than in 2020, the average level of antibodies has dropped because people have not had infectious diseases in recent years", remarks Andréas Werner.
"This has lowered the demand for antibiotics, and therefore manufacturers have reduced their supply."
Drug manufacturers are thus struggling to regain the level of production of antibiotics before the crisis.
While Sandoz, one of the biggest makers of generic antibiotics, says it has ramped up production again, it will take between four and six months to start actually distributing the drugs.
The shortage will therefore not be resolved immediately, even if it should, Hubert Testard hopes, ease in a few weeks, when China will have passed its epidemic peak.
In the meantime, health professionals recommend generalizing screening tests, so as not to prescribe unnecessary antibiotics and to save stocks, while replacing the missing molecules with others when possible.
And to prevent this situation from happening again, the PGEU recommends obliging drug manufacturers to market their products in all Member States and to create a redistribution mechanism in the event of a crisis.
A paracetamol factory should also reopen in Isère, France, but its first drugs are not expected before 2025.
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