Every day, the Berlin pharmacist Fatih Kaynak checks the availability of medicines in the central computer database. Hundreds of drugs are out of stock. “We’re running out of antibiotics, painkillers, but also blood pressure medications and drugs for cancer, stomach and heart,” Kaynak says as he sifts through a long list of unavailable drugs. “It is particularly difficult for us to provide for the needs of children.”
Since they have difficulty swallowing tablets, infants are usually given liquid medication. There are also sweet-tasting painkillers and antipyretics containing paracetamol or ibuprofen. More than ten million packages are sold every year in Germany, but now the shelves of the Kranich pharmacy are almost empty. There are also supply issues penicillin and liquid antibiotics.
“If I want 50 boxes of a rare drug, I may only receive five,” explains the pharmacist.
Desperate parents in Germany have been speaking out on social media for months. Advice for alternative home remedies is highly sought after. But often the only option is a trip to the hospital emergency room – which are exceeded.
Now the head of the medical association, Klaus Reinhardt, has made an unusual suggestion: those who are healthy should donate all the medicine they have at home to sick people in the neighborhood. “We need something like flea markets for medicine,” Reinhardt said in Berlin. Tagesspiegel newspaper this week. These markets could also include drugs whose expiry date has already passed a few months ago, he added.
Thomas Benkert, the president of the Federal Chamber of Pharmacists, is appalled at the idea: “Medicines belong to pharmacies, not to flea markets – and certainly not to expired ones,” he said in a statement.
Alternatives searched
Pharmacies in Germany can often produce medicines themselves, filling between twelve and 14 million prescriptions each year, although this is only a small amount compared to the approximately 1.3 billion packs of medicines sold in 2021 .
Today, many pharmacies have started to mix fever-busting juices for children themselves again – but with the cost of ingredients and staff, the price per bottle is several times higher than that of the standard medicine. “But what does the cost matter when a child has a high fever?” said Kaynak.
It is the current price of medicines that has put Germany in this precarious position. For the pharmaceutical industry, production in Germany and Europe is often simply not worth it. For example, health insurers pay companies €1.36 ($1.44) for a bottle of liquid paracetamol, an amount that has not increased for ten years, while the price of the active ingredient paracetamol has increased by 70% this year alone.
“Rapidly rising prices for active ingredients and production are turning the production of drugs such as paracetamol juice into a loss-making business,” said Andreas Burkhardt, chief executive of pharmaceutical company Teva. “No company can sustain this long term.”
Teva, with its drug brand Ratiopharm, is the last major supplier of liquid paracetamol in Germany – there were still eleven suppliers just 12 years ago. After another manufacturer ceased production in May this year, Ratiopharm now has to cover 90% of demand. This is not feasible, said the manufacturer.
The Federal Institute for Drugs and Medical Devices recently noted that everything had been redeemed. “The availability of products has decreased significantly. At the same time, the sharp increase in purchases has led to regional imbalance and stockpiling,” the institute wrote in a press release.
“Medicines as simple as anti-fever liquid are often no longer available,” explains Thomas Fischbach, president of the Professional Association of Pediatricians and Adolescents. “There are too few suppliers of these drugs because fixed price regulation in our country has led to migration of production to low-wage countries like India and China.” There, he notes, there are also supply chain issues, which in turn lead to supply bottlenecks.
Market shrinkage and its consequences
The problem is not new: in early 2022, Germany experienced a dramatic shortage of tamoxifen, a drug used in the treatment of breast cancer patients. There is no substitute for this drug and critically ill patients need a regular supply. Here, too, there was an acute supply bottleneck because manufacturers had pulled out of production, citing cost pressures.
In February, the Federal Institute for Drugs and Medical Devices intervened and ordered that due to the emergency, alternative drugs containing tamoxifen can now be imported from abroad and sold without German permission. Yet tamoxifen continues to be one of the rarest drugs.
Doctors and opposition politicians are now demanding immediate action from the German government, and experts are calling for government production of life-saving drugs in Germany. It’s time to rethink, they say, and production should be moved from Asia.
German Health Minister Karl Lauterbach responded by promising to invest more in the purchase and production of medicines for children.
This article was originally written in German.
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