Shortage of medicines in France is putting patients at risk, say doctors

French doctors and pharmacists have reported shortages in the supply of a range of crucial drugs including cancer drugs, vaccines and antibiotics - so what is going on?

What is the problem?

The shortages are referred to by the French association of pharmacists as a "supply disruption" and the supply is considered disrupted if a pharmacy or healthcare facility cannot obtained a certain medication for 72 hours or more. If five percent of pharmacies or more cannot obtain the drug, a supply disruption is declared.

What drugs are affected by this?

The three types of drug most commonly affected are vaccines, chemotherapy drugs and drugs connected to the nervous system such as anti-epilepsy medication and Parkinson's disease treatments. However a wide variety of other treatments have also been subject to shortages, including antibiotics, steroids and heart disease medication.

And does this happen often?

Supply disruptions have increased dramatically in recent years, according to an open letter from 20 medics published in French newspaper Le Journal du Dimanche.

France's national agency for drug security the Agence nationale de sécurité du médicament (ANSM) recorded just 44 cases of supply disruption in 2008, but over the years this has increased steadily to 438 in 2014 and 538 in 2017.

The association of pharmacists count the shortages slightly differently - by listing the number of reports made by their members per month. In July 2019, 800 pharmacists reported that a drug had been unavailable for 72 hours of more. Half of the shortages lasted 60 days or more.

A survey for French public health body France Assos Santé showed that one in four French people had been unable to get a medicine that they needed because of a shortage. The figure rose to 31 percent of people with long-term health conditions.

What causes it?

The one thing that all the professionals agree on is that it's complicated. Supply chains for drug manufacturing are long and often involve a lot of different countries, and France is far from the only country affected by this.

However the problem is particularly acute in France because drug prices here are fairly low. This means that intermediary firms that offer short-term supplies in case of shortage prefer to sell to other countries where prices are higher.

Nathalie Coutinet, an economist specialising in the health sector, told AFP: "The production line is completely fragmented in most cases. Research and development is done in one place, the different phases of production in others, like a car being put together."

As well as the complication of the global supply chains there is also rising demand for medicines, particularly vaccines as countries including India and China are organising large-scale vaccination campaigns. Vaccines have a long manufacturing process (up to three years in some cases) so sudden big increases in demand can lead to shortages.

The pharmacutical industry also relies heavily on subcontractors to reduce costs, and this can lead to issues with quality. For example two batches of a widely used anti-hypertension drug have recently been recalled because potentially carcinogenic impurities were detected in one ingredient which is manufactured in China. There have also been shortages of a certain type of steroids after problems with the supply chain in Greece have lead to Greek doctors prescribing an alternative drug, causing a shortage.

Are patients being put at risk?

Yes, according to some doctors, particularly chemotherapy patients, some who have not been able to have their treatment on the timescale recommended because of the shortage of chemo drugs.

Of the patients surveyed who said they had experiences a disruption in their medicine supplies, 14 percent said that their symptoms had got worse and one in 20 reported being hospitalised.

The shortage of vaccines also creates "a potential threat to public health," said Alain-Michel Ceretti, President of France Assos Santé, since it leads to fewer people being vaccinated and therefore decreases the herd immunity.

This is particularly problematic in France, where many people are already not vaccinated because of a widespread skepticism about vaccination.

So what is being done about it?

Well the medics wrote their open letter to the paper to sound to alarm over the urgency of the situation. The government has been putting together a report into the problem, which is due to be presented in September. But such a complex supply system involving so many countries, it's unlikely that there will be any quick fixes. 

Options being explored include better European co-operation and an online reporting system for pharmacies so that shortages can be flagged up early ad alternative arrangements put in place.

In the meantime patients are being warned not to buy their medication online, as there are many counterfeit drugs advertised. Instead they should talk to their doctor about the possibility of prescribing an alternative or consider travelling to a different pharmacy where the drug may be available.