How does France plan to tackle shortages to ‘more than 3,000 drugs’?

President Emmanuel Macron has announced plans to bring back to France the production of certain medicines

Common medications, including the antibiotic amoxicillin, are set to be made in France
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President Emmanuel Macron has announced plans to bring back the production of 50 medicines to France in a bid to reduce the current shortages.

There are currently shortages of more than 3,000 medicines, according to French senator Sonia de La Provôté, who heads up a senatorial commission of inquiry into drug shortages.

Read more: France faces shortages of 3,000 types of medicine

Shortages became particularly acute during the Covid crisis and over the winter when flu and bronchiolitis epidemics also threatened to overwhelm hospitals.

Pharmacists have also shared how they are bearing much of the brunt of the supply shortages. One pharmacist reported that the shortage of a crucial bronchitis drug caused a “fragile” patient to die as a result.

René-Pierre Clément, president of the Union de Syndicats de Pharmaciens d'Officine in Grand Est, told France Bleu: “I called round all the pharmacists. None of them had his treatment. As his body was already very weak, he didn't manage to survive.”

Others have been subject to attacks and aggression from patients who are struggling.

Read more: Drug shortages fuelling attacks on pharmacists in France, says union

Dependence on other countries

China and India produce 80% of the active ingredients in common drugs used in France, such as paracetamol.

Jérôme Martin, co-founder of medical policy observatory l’Observatoire de la transparence dans les politiques du médicament, explained how this dependence can easily cause problems later in the supply chain.

He told FranceInfo: “If there is the slightest problem upstream, even if we have new manufacturers and new manufacturing phases, we will be dependent on this raw material.”

Eight sites across France

Mr Macron has said he wants to end dependence on other countries by bringing the manufacture of common drugs back to France.

He said that he wanted to "secure” medicine supply, "either by diversifying or relocating". Some drugs will start being made within “the next few weeks”, he said.

Eight sites have already been announced across eight manufacturers, with a budget of €160million already promised. They are:

  • Interor (Calais)
  • Seqens, at Porcheville, Limay, and Villeneuve-la-Garenne (Ile-de-France)
  • Euroapi, at Vertolaye (Auvergne Rhône-Alpes)
  • Aguettant, at Lyon (Auvergne Rhône-Alpes)
  • Skyepharma, at Saint-Quentin-Fallavier (Auvergne Rhône-Alpes)
  • Ethypharm, at Grand-Quevilly (Normandie)
  • GSK, at Mayenne (Pays de la Loire)
  • Benta Lyon, at Saint-Genis-Laval (Auvergne Rhône-Alpes).

Which medicines have been announced already?

Common medicines such as the antibiotic amoxicillin, and six anti-cancer drugs, are set to be made in France. Around 50 urgent medicines have already been identified as priorities.

These include:

  • Antibiotics: Amoxicillin, Ciprofloxacin
  • Drugs used in resuscitation and emergency care: Paracetamol, Morphine, Fentanyl, Propofol, Midazolam, Diazepam, Clonazepam, Rocuronium, Adrenaline, Noradrenaline
  • Drugs used in the management of chronic conditions: Methylprednisolone, Esomeprazole, Furosemide, Clopidogrel, Salbutamol
  • Anti-cancer drugs: Topotecan, Melphalan, Busulfan, Fludarabine, Paclitaxel, Oxaliplatin

It comes as the government is set to publish a list of 450 medicines that it considers to be ‘essential’ to guarantee supplies in the country and the wider EU. The ministry has also said that it will continue to identify medicines whose production will be prioritised.

In a press release, the Ministry of Health said: “Despite the presence of many healthcare companies in France and Europe, the Covid-19 crisis has made us collectively aware of the difficulties in our healthcare product supply chains.

“40% of medicines marketed in the European Union come from outside the EU, while 60% to 80% of active pharmaceutical ingredients are produced in China and India,” it said.

The ministry continued: “A number of these medicines are not only critical for our healthcare system, but their supply chains are also vulnerable.

“In particular, these are medicines for which we are heavily dependent on production sites outside Europe, or for which the number of sources is insufficient to provide enough security of supply in the event of difficulties in the production chain.”

Higher medicine prices?

Some have criticised the president’s announcement.

Philippe Besset, president of the pharmaceutical union la Fédération des syndicats pharmaceutiques de France, said the plans would take at least “another five or ten years” to come to fruition.

While Frédéric Bizard, a health economist, told FranceInfo: “Relocation does not happen by presidential injunction. If a private company has no interest in producing, they won't.”

He warned that these ‘made in France’ medicines would likely cost more than those currently made elsewhere.

Natalie Coutinet, health economist, told FranceInfo the plans were an “important step”, but do not go far enough.

She said: “There have been shortages of around 3,500 medicines this year [and] according to the list to be unveiled by the Ministry of Health, there are 450 molecules causing concern, so 25 or 50 relocated drugs is not enough.

“But this is an important first step towards overcoming the shortage situation for a number of so-called 'essential' components.”

She added that only coordination across the European Union would truly let the bloc escape dependence on China, India, and the US.

She said: “The research and development situation in France and the European Union is deteriorating rapidly. We are no longer capable of discovering medicines at the same rate as the United States. Today, most of the drugs coming onto the market come from across the Atlantic. This creates a double dependency.

“Clearly, France alone cannot relocate all the 450 drugs on the government's list. It would not make economic sense, because other European countries also have pharmaceutical expertise. That's why it's absolutely vital for the member countries of the European Union to coordinate their effort.”

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