A fever of 40 degrees is not uncommon in Corona – even in children. But for them there are fewer and fewer antipyretic drugs to buy in Germany. Why is that?
Bed rest and tea can also help at the moment, but some medicines are often out of stock (icon image)
Normal operation prevails in the arcade pharmacy in a shopping center in Berlin. customers come and go. Again and again it is parents who need medicines for fever and pain for their children. Because the youngest are not yet able to swallow tablets, there is a sweet-tasting juice for them that contains the active ingredient paracetamol or ibuprofen. More than ten million packs are sold in Germany every year. But now the shelves are empty.
“The paracetamol juice was already running out at the beginning of the year,” says the pharmacist, who does not wish to be quoted by name. “Meanwhile, ibuprofen juice is no longer available, nor is snuff spray from a large company and things are getting tight for fever suppositories.”
Arcaden-Apotheke in Berlin
There is no improvement in sight, she reports. “With the winter stockpiling, for which the deliveries are scheduled with the manufacturers in the summer, all orders for children's painkillers and fever medication have been completely canceled.”
Lack of raw materials, high demand and no paper
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The Berlin pharmacy is not an isolated case, the delivery bottlenecks affect all of Germany. More and more desperate parents are speaking out on social media. If cold calf wraps don't bring down the fever, perhaps even a febrile seizure, the only option is often to go to the hospital.
“Of course we asked the companies why they couldn't deliver,” reports the Berlin pharmacist. The reasons given were increased demand and a lack of raw materials. “In between, one company said that there was a paper shortage and that's why no packaging was available.”
The corona pandemic has exacerbated everything
Demand from the Federal Association of Drug Manufacturers. Apart from the lack of paper, similar reasons are given. After the abolition of corona measures such as the mask requirement, there were many children with feverish respiratory diseases in the spring. In addition, there were stock purchases due to “media reports about supply bottlenecks”, but also “delivery delays from various active ingredient manufacturers”.
The fever juice is drawn up in a syringe and can be easily administered to the children
In general, the situation in the pharmaceutical industry is also tense, according to a written statement. “Global supply chain problems, the ongoing shortage of skilled workers and corona-related staff absences” would also complicate the situation for drug manufacturers.
It's about the money
The most important reason, however, is financial. It is simply not worthwhile for the pharmaceutical industry to produce painkillers for children. Health insurance companies pay companies 1.36 euros for a bottle of paracetamol juice. This amount has not been increased for ten years. “Rapidly rising drug and production prices with frozen prices make the production of drugs such as paracetamol juices a loss-making business,” complains Andreas Burkhardt, general manager at the pharmaceutical company Teva. “No company can keep up with that in the long run.”
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With its drug brand ratiopharm, Teva is the last major supplier of paracetamol juice in Germany. Twelve years ago there were eleven providers. After another manufacturer stopped production in May, ratiopharm has to cover 90 percent of the demand. But that is unlikely to happen in the foreseeable future. Ratiopharm is the manufacturer that has canceled winter stocking orders. Reason: The “unexpected and sharply increased demand in the market” and the “increased delivery delays of our active ingredient manufacturers”.
Market narrowing and the consequences
At the beginning of the year, the breast cancer drug tamoxifen showed what happens when important drugs are no longer available. A drug for which there is no substitute and which is urgently needed for seriously ill patients. Here, too, there was an acute supply bottleneck because manufacturers had withdrawn from production citing cost pressure.
In February, the Federal Institute for Drugs and Medical Devices (BfArM) intervened and ordered that due to the emergency, drugs containing tamoxifen could now also be imported and used from abroad without German approval. This has not eliminated the supply bottleneck, and another shortage is expected in the second half of 2022.
Pharmacies are mixing themselves again
Overall, the BfArM currently lists more than 260 non-deliverable drugs in Germany. These include common antibiotics, thyroid preparations, antihypertensives and also preparations that are urgently needed in hospitals. In some cases, the pharmacies can ensure the supply by producing the medicines themselves. But for that you need the right raw materials.
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“Basic materials are traded globally and there are often only a few producers of a single active ingredient, mostly in Asia. If there is a problem in a factory in China, for example, or a country imposes an export ban, then many manufacturers are subsequently affected,” explains Ursula Sellering from the Federal Union of German Associations of Pharmacists.
Time-consuming and labour-intensive
Paracetamol is also currently difficult to obtain on the open market. “However, if a pharmacy still has stocks, it can also produce fever juice itself,” says Sellering. Pharmacies today produce between twelve and 14 million prescriptions themselves every year. “Compared to the 1.3 billion packs that were sold in 2021, that's a manageable proportion.”
Sellering suspects it will stay that way. “The production of prescriptions is time-consuming and there is a shortage of staff in the pharmacies as in other areas.” Then there are the costs. Pharmacies that mix fever juice themselves say that if raw materials, personnel costs and effort were to be taken into account, a bottle would have to cost 20 euros.
The pharmaceutical industry wants more money
< p>Teva general manager Burkhardt sees politics as a duty. The “systematic cost pressure” must be eased, “especially for critical drugs that are only produced by a few manufacturers”. The contracts under which health insurance companies only pay fixed amounts would have to be suspended until more companies return to the supply would come in. According to the current ideas of the Federal Ministry of Health, however, this is not in sight. An extension of the status quo is planned – until 2026.