In an open letter published in Le Monde newspaper on March 31, nine hospitals - including the Assistance Publique-Hôpitaux de Paris (AP-HP) CHU of Ile-de-France - wrote: “We will soon be short of essential medicines to treat patients with Covid-19, who are hospitalised in intensive care.”
Many of the medicines “have no equivalent, or it is very difficult [to find them]”, said pharmacologist Bernard Bégaud to news service FranceInfo.
Martin Hirsch, director general of AP-HP, said that stocks in hospitals in Ile-de-France were “very low for certain medicines”. In some regions, such as Nouvelle-Aquitaine, the problem is not yet severe, but there are signs the problem could be spreading.
One chief pharmacist at the CHU in Nouvelle-Aquitaine said that there had been delays in deliveries. She said: “I don’t have a crystal ball, but I would say that our stock cannot be counted in weeks, but in days.”
The warning comes as Prime Minister Edouard Philippe last week told MPs in a Covid-19 committee that “global demand has increased, in a few weeks, by 2,000%” for some medicines.
He said: “Where we would usually have medium-term stock, or even long-term stock, it’s true that we find ourselves managing very short-term stock.”
Pierre Albaladejo, general secretary of French anaesthesia group la Société Française d'Anesthésie et de Réanimation, explained to FranceInfo: “When patients are in intensive care, you need to sedate them, so we need sedatives.
“So in this category we have midazolam, a tranquilizer; and propofol, an anaesthetic. Then, you have to make these patients breathe using machines, and ensure there is no muscular contraction, and that they are being correctly oxygenated.”
Antibiotics are also used to ensure that patients are not exposed to any other infections. Yet, most antibiotics are made in China and India, which were and are themselves fighting the Covid-19 crisis.
India has currently limited the export of 26 medicines, including some antibiotics.
Possible solutions?
Hospital pharmacists have enacted crisis measures, as the situation can change from hour to hour as new patients are admitted.
Anne Gervais, a doctor in the hepato-gastroenterology department of the Bichat hospital in Paris, said: “Intensive care patients are prioritised. Right now, we're going back to older drugs, such as Valium. But if we go on like this, we're going to run out. The whole hospital will feel the effects of a shortage.”
Doctors at the AP-HP hospital are now seeking to change protocol so they can use 20% less medicine, including reducing “the depth of the anaesthesia” or the “degree of sedation”, which would use fewer doses, without any harm to the patient.
But, Dr Gervais said, changing protocols like this requires “more hands, and more supervision”.
Normally, if there is a shortage of drugs in one region, another region may step in, but during the Covid-19 crisis, many hospitals are reluctant to do this, amid fears that the shortage may spread, said Mr Albaladejo.
There is no guarantee that hospitals in less-affected regions would be able to replenish their stocks ahead of the situation worsening.
Drug safety agency l'Agence Nationale de Sécurité du Médicament (ANSM) has said that it is trying to “ease tensions” by using veterinary drugs, especially sedatives that can be used for intensive care patients.
Dominique Martin, director general of the ANSM, said: “These drugs are absolutely equivalent [to human varieties]” - but some doctors have said using veterinary drugs adds an extra level of risk.
President Emmanuel Macron has announced that France has made “massive orders” of medicines in a bid to improve stock levels, but the ANSM has warned that the shortage is not just a problem in France, but also across Europe and worldwide, as the global medicine market is reliant on Asia.
The ANSM has said that it is “working closely” with the European Medicines Agency to coordinate stocks Europe-wide, and seeks regular “stock updates” from the relevant labs.
Meeting demand
Pharmacologist Bernard Bégaud told FranceInfo that current French law requires pharmaceutical companies to hold a stock of four months for the national market, but “this is not enough”. He said: “It should be a stock of six months, minimum.
“That would not have been enough for the current demand, but it would have given us more of a buffer. The industry dragged its feet, and we just agreed with it,” he said, highlighting a senatorial report from 2018, which mentioned “French and European vulnerability [in this area]”.
But the ANSM has said that most pharmaceutical companies will have extra production factories in Europe that they can mobilise to meet increased demand.
For example, the British company GSK - which produces the amoxicillin-based antibiotic Augmentin - has moved part of its production to a factory in Mayenne (Pays de la Loire), “to meet the current hospital needs”, the ANSM said.
Some, including Pauline Londeix, co-founder of the medical transparency group l’Observatoire de la Transparence dans les Politiques du Médicament, requested that the government “requisition production lines” to create urgently-needed medicines, many of which are relatively simple to produce, with the “recipes” in the public domain already.
But government council le Conseil d'Etat rejected the demand, saying that the alleged “lack” was “seriously questionable”.
In response, Ms Londeix said: “We are moving towards a health scandal. This is a question of saving lives, and about giving people the right to die with dignity.”
