Drug shortages denounced by UFC-Que Choisir: “They could be avoided if the authorities banged their fists on the table”, according to an economist

Drug shortages denounced by UFC-Que Choisir: “They could be avoided if the authorities banged their fists on the table”, according to an economist

Nathalie Coutinet suggests several avenues: repatriate production and build up European stocks, increase the number of factories so as not to depend on just one, make the price dependent on supply and toughen the sanctions against firms.

Shortages of molecules of major therapeutic interest can endanger patients (illustration).  (DYLAN MEIFFRET / MAXPPP)

“[Les pénuries] could be avoided if the authorities banged their fists a little on the table ”, denounces Monday, November 9 on franceinfo Nathalie Coutinet, economist and research professor at Sorbonne University Paris Nord, echoing the request of UFC-What to Choose which once again warns of the increase in drug shortages. According to the consumer defense association, there will be 2,400 reports this year, six times more than four years ago. And these shortages mostly affect drugs said to be of major therapeutic interest. Those for which – in case of interruption – the patient’s vital prognosis may be engaged. “Today, we are in a situation where drugs are produced by private firms and behave like private actors seeking to maximize their production”, explains the economist.

franceinfo: The UFC-Que Choisir says that it is because the missing drugs are unprofitable that the pharmaceutical industry is not making much effort. Do you think this reasoning holds?

Nathalie Coutinet:Yes, that’s quite true. The drugs that are most often in short supply are called generic drugs. It is therefore drugs that are old and for which the patents have fallen. And so, from the moment a drug goes generic, its price will drop. It will first drop first when it goes into credits, then it will drop successively over time. And so we arrive at drugs that are inexpensive and therefore that firms do not find profitable enough to continue to produce. They are effectively switching away from these drugs in favor of newer and more profitable drugs.

So in your opinion, could these shortages have been avoided?

They could be avoided if the authorities banged their fists on the table a little. Today, we are in a situation where drugs are produced by private firms and behave like private actors seeking to maximize their production. […] By the time a drug arrives on the market, the price set is generally quite high and the drug is in a monopoly since there is a patent.

You have to understand that companies make a lot of profits when they have a patent and afterwards, in fact, they do less with generics. But that’s the game. We could therefore smooth the price over the entire lifespan of the drug.

Do we need to build up stocks of several months for the most sensitive drugs, as requested by the UFC-Que Choisir?

Stockpiling is complicated, because medicines are also perishable and therefore perhaps an organization already at European level, that would be interesting. What would also be interesting would be to repatriate production to Europe, in particular the production of active ingredients which are today mainly produced in Asia. At that point, we would have a supply that would already be on the territory, closer to the markets. There is also another problem: as these drugs are unprofitable, there are few factories that manufacture them. It would therefore perhaps be necessary to force companies to multiply factories – not ad infinitum – but that there be three or four factories producing a drug. Because in some cases only one factory that produces the drug, so if that factory has a problem, there is no drug left at all. Therefore, increasing the number of production sites could also be a solution that would slow down or reduce certain shortages.

The UFC-Que Choisir denounces the fact that there were only two sanctions pronounced by the Medicines Agency, the ANSM, for out of stock against laboratories in 2019. Should we toughen the response of the authorities public and sanctions?

Yes indeed. Firms really need to feel compelled to build up stocks. For the moment this is not sufficiently the case. It is true that sometimes, they cannot constitute a stock, this is what we saw with the health crisis: when the active ingredients could no longer be produced in China, there was a potential supply disruption. This rupture did not take place, the crisis did not last long enough, but it was potential for the whole world. And we are talking about anticancer drugs and even Doliprane. Today, companies have outsourced a large part of the production of the drug, the active principle, but also certain stages of production. And it is this outsourcing that is the problem […] Over the past ten years, supply disruptions, whether very one-off or longer shortages, have totally exploded. We therefore have a phenomenon which is growing and for which, for the moment, we have not found an effective solution. […] There have indeed been shortages in the past that could endanger patients. When we talk about molecules of major therapeutic interest, they are molecules for which there is no effective substitute. So patients absolutely need these treatments.