Which country offers the most drugs

“The Chinese don't need an atom bomb. They simply do not supply antibiotics [...], then Europe will take care of itself «- this was the statement made by the pharmacy professor Dr. Ulrike Holzgrabe from the University of Würzburg told the ZDF magazine »Zoom« last week. The magazine reported under the title “Medicine in short supply?” On delivery dependencies in the global pharmaceutical market. Some scientists, politicians and market observers fear that the coronavirus pandemic could worsen the problem. Because many important active ingredients are primarily manufactured in China and India, but also in Italy. The general call to produce more in Europe again, as it was also voiced in the EU Parliament last week, is not enough in the current situation. Rather, more drugs “Made in Germany” are needed again.

"As the European Union, we should not be dependent on China economically and in our supply chains to this extent," said Federal Health Minister Jens Spahn on the sidelines of an EU crisis summit on the corona virus. "We have felt that for a long time, not only when it comes to medicines, but also with protective masks." But this is not something that can be solved in two weeks. Spahn, too, would like to see increased drug and active ingredient production in Europe again, but this could take years and need economic incentives. "We will then have to pay more again," and not just cents. Holzgrabe estimates that bringing production back will take at least ten years.

The Federal Association of the Pharmaceutical Industry (BPI) recently published a background paper with the title “Pharmaceutical production in the light of supply bottlenecks”. It should make it understandable that the manufacture of pharmaceuticals is a complex process that is part of the globalized economy. "Basically, the corona crisis has made it even more acute that the relocation of production to Asia makes the supply chains more vulnerable," said BPI Managing Director Dr. Kai Joachimsen. "So that bottlenecks do not lead to supply problems, it would be desirable to secure the European production facilities and relocate production stages back to Europe and Germany."

While biologics and vaccines are largely still produced in Europe, it is above all the low molecular weight generic active ingredients that come from Asia, be it as raw materials for manufacturing or as finished medicinal products. According to ZDF Zoom, 80 percent of the active ingredients come from Asia, especially China, and some of them are further processed in India.

There are also prices that I no longer understand. What can be the quality of paracetamol if I can get 20 tablets for one euro?

Professor Dr. Ulrike Holzgrabe

"As long as generic prices of around six cents are possible for a daily dose, providers will exit the market," warns BPI boss Joachimsen. "And if there are fewer and fewer providers, they cannot compensate for the lack of capacity in the event of delivery bottlenecks." The BPI sees the "sometimes ruinous discount agreements" as jointly responsible and demands that they be redesigned.

In the ZDF Zoom report, all those involved in the pharmaceutical market, from pharmacists and doctors to wholesalers and manufacturers, name discount agreements as a problem. Only the National Association of Statutory Health Insurance Funds denies this.

What has to change?

First, the BPI proposes a points system for the sub-steps of production. If these take place in Germany or Europe, this should be honored when the award is made. Secondly, active substances / drugs that have repeatedly shown a supply deficit in the past two years should no longer be put out to tender for a period of two to three years. Third, the health insurance companies should only use the multi-bidder model, in which at least one of a total of three surcharges should go to a company with German or EU production.

"With production in Germany or Europe, the probability of a reliable, improved, continuous supply of medicines to the population can be increased," writes the BPI. "The manufacture of finished products can again be increasingly realized in Europe without major problems, the basic structures are in place, this could be politically supported through increased funding." SPD health expert Karl Lauterbach says in the ZDF Zoom report that such state interventions, producers in Preferring Germany and Europe can now be justified.

Medicines are not a commodity like a car, like a bicycle, like a mixer […], it's about our health. The medicine should not have been made into an ordinary commodity.

Professor Dr. Ulrike Holzgrabe

However, Germany and Europe have already lost a great deal in the production of active ingredients due to their migration to other parts of the world. The retrieval of active ingredient production is only feasible to a limited extent, since large investments would be necessary, which would have to be funded. The antibiotics expert Holzgrabe estimates in the ZDF report that the reconstruction of the corresponding capacities would take at least ten years.

The BPI also refers to higher production costs and higher regulatory effort. The health insurance companies would have to be prepared to accept corresponding additional costs for delivery capability and patient care. It is the question of what is more dear to us as a society - reasonable prices for drugs or dependence on other countries.

According to the National Association of Statutory Health Insurance Funds, discount agreements help companies plan. The health insurance companies demand that delivery failures at discount partners be sanctioned. Pharmacists would have to be financed from this money for their additional work in consulting. Most importantly, an obligation to report in the event of impending delivery bottlenecks. At present, such reports from the pharmaceutical industry to the BfArM are still voluntary, which explains the discrepancy between the authority's supply bottleneck database and everyday life in the pharmacy.