Pharmacies across the UK and France are running out of a key antibiotic as doctors see a post-pandemic rebound in winter infections such as strep throat.
In Britain, the Association of Independent Multiple Pharmacies has called the shortage of amoxicillin “very worrying” as the country experiences a surge in scarlet fever and serious Strep A infections that has already killed nine children.
Health professionals are also warning of potential shortages in other European countries such as Italy, as well as in Canada and the United States.
In France, the government has acknowledged that supplies were tight for both amoxicillin and common painkiller paracetamol, but that patients were still able to find what they were being prescribed.
Emma, a mother of two in Lyon, says she trekked to six different pharmacies in late November before she could find amoxicillin to clear up her three-year-old son’s ear infection.
“I found the amoxicillin in the sixth pharmacy and it was the last packet,” she told Euronews Next. “In each one, they said they could try to order it but it wouldn’t arrive until a week later”.
She also struggled to find the liquid form of paracetamol, which is usually sold over the counter, for her three-month-old daughter who had bronchiolitis.
“It was a really stressful experience. When your child is ill, all you want to do is make them feel better,” she said.
What is causing medicine shortages?
The phenomenon is not new, but it has worsened with the COVID-19 pandemic and the war in Ukraine.
"The situation has been very bad over the years in all countries, and affecting all types of medicines,” said Ilaria Passarani, Secretary General of the Pharmaceutical Group of the European Union (PGEU) representing community pharmacists.
“For the past seven, eight years, we have seen the problem increase," she told Euronews Next, adding there were fundamental causes driving this trend as well as more circumstantial ones.
The main reason has to do with the globalisation of drug manufacturing, which sees the various stages of medicine production split up into multiple sites around the world.
China and India are estimated to produce between 60 per cent and 80 per cent of the world’s active pharmaceutical ingredients. This concentration of the market comes with risks.
“If there is a problem with a specific producer, then you have a shortage worldwide,” Passarani said.
A manufacturer can also decide to stop producing a product when it is no longer profitable enough, leaving buyers with very few alternatives.
And any glitch in supply chains can easily cause disruption. In 2019, an exclusive report by Vice found that 14 mental health drugs were in short supply after Brexit.
These days, additional factors are contributing to the bottleneck. Since the war in Ukraine, the pharmaceutical industry - like many sectors - has been hit by high inflation.
The conflict has led to higher energy costs and more expensive raw materials for manufacturers.
Lastly, even as COVID-19 persists, other diseases are making a comeback after having kept a low profile amid lockdown restrictions.
In fact, this is how French authorities have explained the dwindling supplies of amoxicillin. According to them, manufacturers were caught by surprise by a strong rebound in demand.
“So, the problem we're facing with medicine is the same problem that we might face with microchips, that is also affecting other sectors of the economy,” Passarani said.
“But medicines are not like any other good, and a shortage can put patient safety at risk”.
Which medicines are affected?
That question depends on the country.
In the UK, pharmacies are sounding the alarm on amoxicillin, one of the antibiotics most commonly prescribed to children - including for strep A infections, which are currently surging nationwide.
During the summer, the UK also experienced shortages of some diabetes drugs, while aripiprazole, a drug prescribed for certain psychiatric conditions including schizophrenia, bipolar disorder and severe autism, was also in short supply.
In France, paracetamol is affected, to the extent that the authorities have recommended that pharmacists sell no more than two boxes per patient. Short supplies have also been reported for some diabetes drugs.
In the United States, patients with attention deficit hyperactivity disorder (ADHD) are facing difficulties obtaining Adderall. Production delays, overprescription, regulations and high demand are all cited as playing a role.
In Ireland, more than 180 products were "in short supply" in September, according to Medicines for Ireland.
What solutions are being considered?
Measures are already in place in some countries, such as allowing substitution by a generic drug. Some countries - such as France - also have legislation obliging manufacturers to provide minimum safety stocks for certain medicines.
In March 2022, the European Medicines Agency (EMA) set up a steering group to address supply problems. The group is working to ensure better communication and coordination between the different players across the industry.
Health professionals' and patients' representatives are hoping for more action as part of new regulation currently being discussed in Brussels. The European Commission's proposal is expected by the end of this year.
"We are also asking for solutions that can be implemented now at a national level. By expanding the role of pharmacists, something can be done without waiting for the long, long revision of the EU legislation that will take years," said Passarani.
She cited how during the COVID-19 pandemic, pharmacies in some countries were able to substitute medicines experiencing shortages without the patient having to go back to the doctor and ask for another prescription.
But critics say measures like these do not fix the roots of the problem. From government officials to analysts, there are growing calls to shift medicine production back from Asia to Europe.
The French government has already taken financial incentives to "repatriate all these industries that produce essential medicines," François Braun, France’s health minister, said last month.
The pharmaceutical industry lobby has signalled it’s willing to bring some production back to Europe, but notes that red tape can be a hurdle. It also argues that France’s health system offers little incentive to do so given the low sales prices it imposes for reimbursable drugs.
Can these medicine shortages endanger patients?
In a study conducted by The Pharmaceutical Journal in July 2022, more than half of the UK pharmacists surveyed felt that the shortage of medicines was putting patients' health at risk.
A recent French study found that replacing one drug with another led to medication errors in 11 per cent of cases.
“For many medicines, especially for rare diseases, often you don't have alternatives,” Passarani said.
“But also, you have to take into account that even just changing a medicine with an alternative one can increase the risk of side effects or have a different effectiveness, meaning lower health outcomes and a lower benefit for patients”.