Germany sees alarming shortage in medicine

It's business as usual at the Arcades Pharmacy in Berlin. Customers come and go — many of them are parents looking to stock up on medication used to combat fever and pain, which can be a problem also with a COVID-19 infection.

For younger children who can't swallow pills, there's a sweet-tasting juice containing either paracetamol or ibuprofen. Normally, more than 10 million small bottles of this medicine are sold each year. Now though, shelves are beginning to look empty.

"The paracetamol juice was already beginning to get a bit scarce back at the beginning of the year," says one chemist, who didn't want to give her name. "Meanwhile, we're out of stock on ibuprofen juice, as well as nasal spray. And supplies of fever suppositories are low."

What's more, she adds, there's no improvement in sight: "We've been stocking up for the winter, which means coordinating deliveries now. And what we're seeing is that all contracts for anti-pain and anti-fever medication for kids have been canceled."

Supply shortages, high demand

The Berlin pharmacy is no exception: supply shortages are having an impact across the country. More and more desperate parents are using social media to share their distress as they fail to bring their children's fever down or fight painful fever cramps.

Pharmaceutical companies fail to make their scheduled deliveries citing booming demand coupled with a shortage of raw materials. 

After the easing of anti-COVID-19 restrictions such as the mandatory wearing of masks, German pediatricians saw lots of children with respiratory illnesses and runny noses. And pharmacies saw customers stock-purchasing after media reports of serious bottlenecks in supply chains and delays in delivery schedules.

The pharmaceutical industry currently faces problems with supply chains plus a lack of skilled workers. But for years now, they have not made money off producing painkillers for children. Health insurers pay €1.36 ($1.39) for a bottle of paracetamol juice. The same amount as ten years ago.

"Rapidly rising active ingredient and production prices have turned the production of drugs like paracetamol juices into a loss-making business," complains Andreas Burkhardt, general manager at the pharmaceutical company Teva. "No company can sustain that in the long run."

Pharmaceutical giant Ratiopharm still produces such medication. But now they have also canceled orders for winter stockpiling. Due to "unexpected and massively growing demand in the market" and the "increased delivery delays among our active ingredient manufacturers."

Where it leads when important drugs are no longer available became clear at the beginning of the year with the breast cancer drug Tamoxifen — a drug for which there is no substitute and which is urgently needed by many chronically ill patients.

Here too, there were serious bottlenecks partly triggered by manufacturers who had withdrawn from production, citing cost pressure.

In February, Germany's Federal Institute for Drugs and Medical Devices (BfArM) waded in and ordered that, in light of the emergency, medicines based on Tamoxifen may now also be imported from abroad. This does not solve the supply problem; the next scarcity is expected for the second half of 2022.

Chemists again mix their own potions

Germany's BfArM currently lists more than 260 medicines that are currently not available in Germany. These include common antibiotics, thyroid medicine, blood pressure reducers, and also medicines that are urgently required in hospitals. In some cases, chemists guarantee supplies by producing their own medicines. But for that, they still need the appropriate raw materials.

"Basic materials are traded globally and there are often only a few producers of a single active ingredient, mostly in Asia. If there is for example a problem in a factory in China, or one country imposes a trade embargo, then many producers are subsequently affected," says Ursula Sellering of the German Federation of  Pharmacists.

Paracetamol, too, is currently difficult to obtain on the global market. "However, if a pharmacy still has stocks, it can also produce its own anti-fever medication," says Sellering. 

That's the way it's likely to stay, he warns. "The production of medicines is time-consuming and there is a lack of staff in pharmacies and other sectors." Not to mention the costs. 

Andreas Burkhardt, at the pharma company Teva demands that "systematic financial pressure" must be eased, especially for critical medicines that are only produced by a few manufacturers." The contracts under which health insurance companies pay fixed amounts, he says, should be suspended until more and new competitors could enter the supply again.

This is not in sight, at least not according to the current ideas of the Federal Ministry of Health. The plan, it seems, is to extend the status quo —  until 2026.

This article was originally written in German.

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