It is waiting for the unnecessary death of a patient who did not receive his medication on time. Or who dies from serious side effects of a substitute. Only when such a patient appears on television will the chronic shortage of medicines that pharmacists, general practitioners and patients have been dealing with for years be given a face.
Last year, 1,514 medicines were not available for more than two weeks. That’s it, according to the pharmacists highest number ever. These include generic medicines that millions of people use: antibiotics, sleeping pills, medicines for ADHD, but also, for example anti epileptics. There was already a shortage of the contraceptive pill in 2018.
The cause is the cheap production and distribution chain. These kinds of mass medicines are almost exclusively produced in China and India, at rock bottom prices for the whole world. If something goes wrong in a large factory or at one distributor, if there is a pandemic or a war, supplies will come to a standstill. The Netherlands is a smaller market than Germany or France and also pays as little as possible for pills. So Dutch wholesalers are at the back of the queue when there are delivery problems.
Two weeks ago pharmacists, doctors and patients wrote an urgent letter to Minister Kuipers (Public Health, D66): “The price-lowering policy is causing great concern about availability, especially for generic medicines.” Pharmacists must always explain to patients at the counter that their regular medicine is not available and that they will be given another medicine. Not every patient wants that. Sometimes because they think that a substitute is less good and looks different, but sometimes because it really is. Or cause other side effects.
The problem seemed to be solved with the obligation that Minister Kuipers has imposed on pharmaceutical wholesalers since 1 January to build up a permanent stock of medicines. Enough of each substance for at least 2.5 months.
But this year the Inspectorate has not yet checked this mandatory stock. And the largest of the four wholesalers, Brocacef, recently announced no to build up stock. “It is not unwillingness,” says director Peter de Jong. “I don’t have the space because I need to create new storage space, I don’t have the financing and I can’t afford the costs. A transitional arrangement will apply this year, but from 2024 a maximum fine of 900,000 euros per product will apply if there is not enough stock.” In order to avoid fines, he will then remove the medicines that are “most sensitive to shortages” from the range.
Patients will not care how it is solved – they have something else to worry about and also pay a monthly mandatory health insurance premium. But it is very probable that the market will not just build up the ‘iron stock’. The wholesaler works with as little stock as possible because storage costs money. The government or health insurers will have to step in to make the surcharge financially possible. In Germany, pharmacists are now reimbursed if, due to a lack of a certain medicine, they are forced to provide a similar, more expensive, medicine.
It has to be done, as four people involved recently NRC wrote, come up with a “system solution” to keep generic drugs available and affordable for patients. In addition to an iron stock, generic drugs could also be produced in the Netherlands again. The Dutch manufacturer, InnoGenerics, which had been trying to produce patent-free drugs since 2019, went bankrupt in January. The company was subsequently saved.
But there is no other solution if the Netherlands does not want to be constantly dependent on the world market and producers in China and India, and at the same time wants to pay lower prices for pills than neighboring countries. The government will have to come up with more than high fines for market parties in a difficult market.
The corona pandemic showed that the Netherlands was not prepared for a calamity for many medical products – from face masks to oxygen equipment. Later, when the vaccines came on the market, the Netherlands was at the back of the procurement queue. The distribution of the vaccines also took a long time, so that the Netherlands always dangled at the bottom of international progress lists.
It would therefore not be surprising if the Netherlands continues to dangle at the bottom again with medicine shortages.
A version of this article also appeared in the newspaper of February 11, 2023