what’s causing them and how countries can minimise the impact

what’s causing them and how countries can minimise the impact

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A large number of antibiotics are currently in short supply across Europe. For example, in the UK, the availability of amoxicillin and penicillin, used to treat infections such as streptococcus A, is low.

Drug shortages are a significant problem worldwide, affecting patient well-being and the cost of care. A 2021 survey of community pharmacies in 27 European countries confirmed that shortages are an ongoing problem.

The current shortage of antibiotics could negatively impact patients and raise public health concerns. So what is causing these shortages, and what can we do to ensure people who need antibiotics have access to the right ones?

Read more: Strep A: Three doctors explain what to look out for

Our research on drug shortages suggests that antibiotic supply problems are in many respects no different from other recent cases of drug shortages. They are the result of known demand and supply problems.

On the demand side, changing infection patterns and possibly also the ongoing cold spell have contributed to the above-average use of antibiotics.

In the UK, for example, medical experts have stated that cases of scarlet fever and strep usually increase in the New Year. But changing levels of immunity in the population related to the COVID pandemic appear to have affected infection cycles.

The earlier-than-usual rise in the disease was largely unexpected, invalidating demand forecasts and disrupting manufacturers’ production schedules. Accordingly, pharmacies have reported difficulties in securing supplies of essential antibiotics to meet the surge in demand.

In addition, changing prescribing patterns can contribute to spikes in demand. A recent change in recommendation in England allowed the use of antibiotics for children at risk of streptococcus A as a ‘blanket measure’, which in turn likely increased demand for penicillin and amoxicillin.

On the supply side, over-reliance on a small number of suppliers for APIs and other raw materials has made it difficult for manufacturers to meet current demand. A particular challenge has been China’s zero-COVID policy and the restrictions this has placed on manufacturing output and logistics.

More broadly, the heavy reliance on specific countries as the main sources of ingredients and raw materials is a significant concern. China and India together accounted for more than 60% of the global supply of active pharmaceutical ingredients in 2020. This level of concentration in the supply market can lead to serious availability problems if drug supply chains are disrupted.

Another important problem is that many antibiotics, especially those not protected by patents (commonly known as “generics”), are very cheap. Although low prices make these antibiotics affordable, they also reduce the financial attractiveness for manufacturers, who may decide to stop production when supplying these products is no longer economically viable.

Rising energy costs exacerbate these challenges because they increase production costs, which has contributed to some antibiotic manufacturers shutting down production.

problems for patients

When people cannot access the antibiotics they need, it leads to more serious cases of illness. In very severe cases it can be life-threatening.

The majority of amoxicillin and penicillin-based products are “narrow-spectrum” antibiotics, meaning they target a specific group of infections. A shortage of these products could increase the use of “broad-spectrum” antibiotics, designed to treat a variety of bacterial infections.

Although better than leaving infections untreated, broad-spectrum antibiotics increase the risk of antibiotic resistance, making infections more difficult to treat long-term.

A man touches his daughter's forehead and holds a thermometer in his hand.

what can be done

Given the public health risks involved, it is imperative that antibiotics go to patients who need them today, rather than being held back for patients who may need them tomorrow.

One immediate action governments must take is to actively discourage hoarding by individuals and healthcare professionals to ease demand pressures. The British government has already taken steps in this direction. On the pharmacy side, instead of building up emergency stocks, pharmacies could share information about their stock levels and work together to share stock levels as needed.

Governments that reimburse pharmacies for costs associated with antibiotic price increases to ensure they maintain healthy profit margins can help ensure continuity of supply. Medical experts could also review prescribing guidelines so that the use of antibiotics is only recommended in cases where serious health consequences are expected. This would help manage demand more effectively.

Read more: Why so many medicines are out of stock – and what to do if it affects you

Governments also need to work with manufacturers and wholesalers to review their stockpiling policies. Investing in sufficient buffer stocks of antibiotics to accommodate seasonal spikes in demand can help suppliers and healthcare professionals buy time when a supply/demand imbalance occurs. Any cost increases related to supply chain actors holding safety stocks could be covered by either direct government payments or product price increases.

Ultimately, however, addressing drug shortages will require rethinking procurement systems to incentivize security of supply and reduce reliance on distant suppliers of APIs and raw materials. The latter could, for example, involve joint investments in regional production centers in Europe.

This article was republished by The Conversation under a Creative Commons license. Read the original article.

The conversation

The conversation

Kostas Selviaridis has received a grant from the Research Council of Norway for the research project ‘Measures to improve the availability of medicines and vaccines’ (MIA).

Nonhlanhla Dube has received funding from the Research Council of Norway for research on ‘Measures to improve availability of medicines and vaccines’ (MIA).

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