Worrying shortage of medicines in Switzerland
Published: Sunday, Dec 24th 2023, 11:20
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Many medicines are not available in Switzerland or are difficult to obtain. For around 200 of these, the shortage poses a serious problem. Following the shortage of these medicines last winter, the situation remains critical even for common products.
The list of missing products and substances compiled by specialized websites is long. Whether on drugshortage.ch, the platform for drug shortages of the Geneva University Hospital (HUG), the online pharmacy Zur Rose or the list of the Federal Office for National Economic Supply (FONES) - the situation is very tense.
For example, drugshortage.ch lists 786 missing products, including 360 active ingredients. Amoxicillin (antibiotics), injection solution for diabetics (Ozempic), vaccinations for children or against rabies, tranquilizers such as benzodiazepines, painkillers - there is a lack of many things.
"We have two people working full-time to look for alternatives to bridge supply shortages. The situation affects all classes of medicines," HUG head pharmacist Pascal Bonnabry told the Keystone-SDA news agency.
He speaks of a "worrying" development that is affecting the whole country. "Since last winter, which was particularly difficult, the situation has stabilized at a high level (of scarcity)," Bonnabry adds. Overall, the situation has continued to deteriorate in small steps over the last 10 to 15 years.
Great dependence on Asia
Christoph Amstutz, Head of the Therapeutic Products Division at BWL, points to Europe's "heavy dependence" on Asia (China, India) for active ingredients, which leads to many problems. The closure of production facilities and the relocation of sites over the past 15 years has been a "big mistake", he said.
Although the prices of some medicines have fallen tenfold or more, one "grain of sand" is enough to disrupt the entire supply chain. Between Covid-19, factory accidents and the war in Ukraine, the world is now facing a storm of "grains of sand" that is disrupting the production and transportation of the active ingredients as well as the manufacture of the drug itself and the packaging.
The situation is "more dramatic than ever before", worries the supplier Zur Rose: "The shortage primarily affects cheap, common drugs that are no longer protected, generics such as painkillers, antibiotics, cough syrups, cancer drugs, but also blood thinners or Temesta," said communications manager Simon Marquard.
Switzerland stands outside
At the beginning of the month, the European Commission published a list of over 200 substances and several hundred medicines that are considered "critical" for the EU and for which it wants to strengthen Europe's autonomy.
Switzerland is trying to negotiate a solution with the EU, said Amstutz. The fact that Switzerland is outside the EU does not make things any easier. Another major risk factor is the high concentration of the industry. For example, a third of the active ingredients of generics for the US market are manufactured at a single site, mostly in India or China, as the Clarivate Analytics' Cortellis Generics Intelligence database shows.
For Europe, another study by MundiCare found that 70 percent of generics manufactured in Europe and Japan contain active ingredients from China. According to the study, the West has massively outsourced production over the last 15 to 20 years.
High margins
Switzerland may be the land of the pharmaceutical industry, but the Basel-based companies are now concentrating primarily on prestigious drugs with high margins, according to one conclusion of the discussions. Everyday products such as the sedative Lexotanil (or Lexomil), once the pride of Sandoz, are now produced by other, smaller manufacturers who are often unable to keep up.
Patients sometimes have no choice but to take a less suitable alternative product. Or they stock up on medication in foreign pharmacies, for example in Annemasse in France, as a pharmacist in the Haute-Savoie region said.
As there was also a lack of common products, this led to a shortage of other drugs that patients had to fall back on: the shortage of Temesta had a snowball effect, increasing the demand for Lexotanil and other tranquillizers.
Older people particularly affected
The problem mainly affects older people. Those who are used to resorting to (over-the-counter) tranquillizers are sometimes given antipsychotics as standard, which are very strong drugs. This does not make the situation any easier, the report continued. According to the experts, the situation is all the more difficult because the problems of many areas such as politics, the economy and health are interwoven, and on a global level too.
The Federal Office for National Economic Supply only deals with so-called critical or life-saving medicines, a category for which it had to create compulsory stocks (for three months) for 200 products. In the eyes of some pharmacists, however, this list is far too restrictive. According to HUG head pharmacist Bonnabry, it is three times shorter than the list of critical medicines recognized by the EU.
Until the cause of the problem has been resolved, the Swiss task force "Shortage of medicines" continues to recommend that certain medicines be dispensed in partial quantities. This means that medicines are removed from their packaging and dispensed in limited quantities.
©Keystone/SDA
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