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French doctors call for ‘action plan’ on scarce drugs

Doctors and medical associations in France have called for an “urgent plan of action” to ensure the country does not run out of life-saving medicine, amid reports that more drugs are becoming scarce.

In an open letter published in newspaper Le Parisien this week, patient associations and neurologists said that medicines for diseases such as Parkinson’s are frequently in too-short supply across France.

Medicines for conditions such as cancer of the bladder, blood, and ovaries are also reported as scarce, as are vaccines including DT Vax (diphtheria and tetanus), Imovax (polio), Ticovac (encephalitis) and the BCG (tuberculosis).

In 2017, national medicine agency l'Agence Nationale du Médicament received 530 reports of a severe lack of stock; which is counted every time a pharmacy or clinic is unable to dispense a prescription medication within 72 hours of a request.

Between 2008-2018, the number of unavailable medicines has risen tenfold, according to figures from health agency l'Agence Nationale de Sécurité du Médicament et des Produits de Santé (ANSM).

This is usually due to “production difficulties”, it said, including “delays or incidents at the source of manufacture”. Difficulties in sourcing raw materials for certain medicines account for 17% of stock delays, it said.

The open letter read: “The globalisation of the production and demand [of drugs plays a role]. 70% of main active ingredients are made in the USA or Asia, on a small number of sites. One little problem in a factory, and it’s a catastrophe [for everyone else].”

One manufacturer of Parkinson’s drug Sinemet, based in the USA, the letter said, was “forced to close its doors” temporarily to deal with the rising backlog.

Vaccinations can also pose problems. Due to their being a living, biological product, it can take between 18 and 24 months to produce them, so “when there is a lack of vaccinations, we cannot just replace them the next day”, the letter explained.

Laboratories are also reportedly reducing stocks to save costs, and may offer more drugs first to markets that pay higher prices than France. Some labs have stopped producing older medicines, the letter alleged, because their price has been deemed as too low.

French pharmacist group L'Ordre des Pharmaciens has put an alert system - named DP-Ruptures - in place to help, which is designed to reduce the amount of time that medicines are not available in pharmacies.

Similarly, a Senate report, published at the beginning of October, suggested 30 ways to prevent continued lack of stock.

It recommended that more funding be given to two organisations able to provide essential medicines in France: the central army pharmacy, and the l'Agence Générale des Équipements et Produits de Santé (AGEPS).

Yet, some specialists say this is not a sustainable option, as the cost is considerable and it can be difficult to choose exactly which medicines are needed as priority.

The report also recommended a “carrot and stick approach”, including financial incentives for pharmaceutical companies that make medicines in France (thus increasing their availability), alongside sanctions for those that do not manage stock scarcity properly.

Despite certain delays, members of the public are advised against buying medicines online or from other sources, even for drugs that appear scarce, as ANSM judges the risk of counterfeit and unsafe products to be too great.

Physicians and doctors are advised to seek alternative types of treatment in the event that a specific medicine is not available, although these may also be scarce too, depending on the drug.

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