The supply of medicines in Germany is strained.Image: dpa / Jan Woitas
Watson answers
Stabbing and throbbing pain in right lower back. A tug with every movement. Fever, chills, nausea: Kidney and pelvic inflammation is not something to be trifled with. Fortunately, there are antibiotics that fight the bacteria within a few days and alleviate the symptoms in a short time. Modern medicine – which is currently reaching its limits.
Not because the drugs suddenly no longer help against new types of killer bacteria. No, the antibiotics are still working well. But they are becoming increasingly rare. There is still a shortage of medicines in Germany and Europe. And the tense situation could get even worse.
Why is that? Where does the shortage come from? And what kind of medication is it? Watson clarifies the most important questions for you.
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Where is the bottleneck coming from?
As is so often the case, a key word in this problem is globalization. Of course, the causes of the shortage are complex. The Federal Union of German Associations of Pharmacists (Abda) cites the strong specialization as a reason in addition to the globalized manufacture of medicines.
For some active ingredients, there are only a few manufacturers worldwide. And that means that production downtime or quality problems in a single plant could have a massive impact on the European market.
For many manufacturers, the production of patent-free medicines in Germany is no longer worthwhile. This is one of the reasons why the manufacture of many medicines has been relocated abroad or stopped altogether. Me nothing, you nothing, the production capacities can not be ramped up either.
Some medicines are only manufactured in individual production facilities.Bild: IMAGO/ITAR-TASS / imago images
For months now, practices and pharmacies have been complaining about delivery bottlenecks. In the winter months in particular, respiratory diseases and childhood illnesses such as the RS virus drove demand up. But even now, when temperatures are slowly rising and winter is drawing to a close, pharmacies are sounding the alarm: Instead of an improvement, a further deterioration is in sight.
The fact that the situation in the supply chains has eased, as Health Minister Karl Lauterbach (SPD) claims, is simply wrong, explains Abda President Gabriele Regina Overwiening at a press conference. “In modern German, it’s fake news.”
Why could the situation get worse?
The reason for the further deterioration of the situation is a legal regulation that was originally supposed to expire after Easter. To be more precise, the nationwide regulation on the “SARS-CoV-2 Drug Supply Ordinance”. The regulation was introduced to avoid multiple visits to the doctor and pharmacy.
Because the regulation made it possible for pharmacists to offer pragmatic solutions for missing products. Especially when a prescribed drug was no longer available in the right pack size or potency. But that will end after Easter. Instead of the simple workaround, the patient would then have to visit the practice again to pick up a new prescription.
The same applies to medicines with the same active ingredient. So far, pharmacists have also been able to dispense suppositories if a prescribed juice is no longer available.
Health Minister Karl Lauterbach must now act quickly to get the bottleneck under control.Image: IMAGO/photothek / Sebastian Rau
With a view to a draft from the Ministry of Health, Overwiening says that this ignores the reality of supply in pharmacies. Lauterbach only wants to keep the more flexible rules for medicines that are on a corresponding list of the federal government, criticizes the Abda President.
However, the local pharmacist knows best where medicines are scarce. Die Politics must enable him to make decisions in the interests of the patients so that they can get their medication quickly. “Everything else leads to chaos,” says Overwiening. The more flexible rules were originally supposed to run until the beginning of April – due to an amendment, the rule should now last until July.
After that, at the latest, a permanent solution is needed, Overwiening demands. When asked by Watson, the Ministry of Health said that there are currently plans to extend the applicable rules. At least until a new law comes into force.
What medicines are they?
Basically, there is currently a lack of everything: fever syrups, cough medicine, antibiotics, antihypertensives, painkillers, penicillin, cancer, stomach and heart medication. The “German wave” reports on 425 medicines that are missing nationwide. The article also quotes the result of a survey by the North Rhine-Westphalia Association of Pharmacists:
“Almost every second prescription that is presented to them by customers is now affected; the additional expense would result in monthly costs of around 3,000 euros per pharmacy.”
And when things get tight, the pharmacies have to improvise. Then there are fever suppositories instead of fever juice, 400 mg ibuprofen instead of the 800 mg version – or even more aggressive antibiotics.
“The antibiotics that we currently have to use are not first-choice drugs and could promote the development of resistance. But there are currently no longer first-choice antibiotics,” explains Martin Schulz, Managing Director of Drugs at Abda Berlin, in an interview with watson. What that means for the future cannot yet be foreseen.
So far, however, it has always worked to counteract a supply bottleneck with ad hoc measures, says the pharmacist and pharmacologist. With a view to current developments, such as diabetes medication being viewed as a weight loss miracle or people stocking up on painkillers and fever syrup for fear of a bottleneck, it remains to be seen how the supply situation will develop.
What could help?
There is no simple solution to the problem, says Schulz. Neither can the entire drug production go back to the EU or even brought to Germany, nor would it make sense to rely solely on stockpiling. Instead, he advocates diversifying supply chains. It’s about, he says, that several manufacturers have to be distributed around the world.
Martin Schulz is the head of the Berlin Abda. Image: Has dev settings / Martin Jehnichen / ABDA
From the point of view of the pharmacist, the health insurance companies should also make sure that their discount partners do not only conclude their contracts with one provider. “If that fails, thousands of patients will suddenly be left without medication,” says Schulz. And the pharmaceutical companies shouldn’t buy all their preparations from the same manufacturer, says Schulz.
Discount drug – what is that?
The health insurance companies conclude contracts with pharmaceutical companies. The companies grant the health insurers a discount on a specific drug or the entire range. In return, the health insurers assure that their policyholders will usually receive the drug from the partner manufacturer.
Schulz believes that the accusation that pharmacies are circumventing the discount agreements through the exception rule is unjustified. On the one hand, the simplified procedure did not result in additional costs during the pandemic. On the other hand, nothing is easier for pharmacists than dispensing the prescribed medication. In the event of a bottleneck, however, this is often not possible on a daily basis.
(With material from dpa)
