Every day, Berlin pharmacist Fatih Kaynak checks the availability of medication in the central computer database — only to see that hundreds of drugs are still out of stock.

"We are short of antibiotics, painkillers, but also blood pressure reducers, and cancer, stomach, and heart medication," said Kaynak, as he scrolls through a long list of drugs that are unavailable. "It's especially difficult for us to supply children."

Since they find it hard to swallow tablets, infants are usually given liquid medicine. Sweet-tasting painkillers and fever-reducing drugs containing paracetamol or ibuprofen are also in high demand for this age group. More than 10 million packages are sold in Germany every year, but now the shelves in Kaynak's pharmacy are almost empty. There are also supply problems with penicillin and liquid antibiotics.

"If I want 50 packs of a scarce drug, I might actually get only five," said Kaynak.

Desperate parents in Germany have been speaking out on social media for months. Tips for alternative home remedies are much sought after. But often the only option is a trip to the hospital emergency rooms — which are overwhelmed.

Now the head of the medical association, Klaus Reinhardt, has made an unusual suggestion: those who are healthy should give any medicine they have at home to sick people in the neighborhood. "We need something like flea markets for medicine," Reinhardt told Berlin's Tagesspiegel newspaper this week. Such markets could also include medicines whose expiration date has already passed a few months ago, he added.

Thomas Benkert, the president of the Federal Chamber of Pharmacists, is appalled at the idea. "Medicines belong in pharmacies, not in flea markets — and certainly not expired ones," he said in a statement.

With prices increasing, pharmacists looking for alternatives

Pharmacies in Germany can often produce medicines themselves, filling between 12 and 14 million prescriptions each year — though that's only a small amount compared to the approximately 1.3 billion drug packages sold in 2021.

Now, many pharmacies have begun to mix anti-fever juices for children again — but with the cost of ingredients and personnel, the price per bottle is several times that of the standard medicine. "But what does the price matter when a child has a high fever?" said Kaynak.

It's the current price of medicine that has put Germany in this precarious position. For the pharmaceutical industry, the production in Germany and Europe is often simply not worth it. For example, health insurers pay companies €1.36 ($1.44) for a bottle of liquid paracetamol, an amount that hasn't increased for the last decade even though the price of the active ingredient, paracetamol, has risen by 70% this year alone.

"Rapidly rising active ingredient and production prices turn the production of drugs such as paracetamol juices into a loss-making business," said Andreas Burkhardt, general manager at the pharmaceutical company Teva. "No company can sustain that in the long run."

Teva, with its drug brand Ratiopharm, is the last major supplier of liquid paracetamol in Germany — just 12 years ago, there were still 11 suppliers. After another manufacturer ceased production in May this year, Ratiopharm now has to cover 90% of the demand. That is not feasible, the manufacturer said.

The Federal Institute for Drugs and Medical Devices noted recently that everything has been bought up. "The availability of the products has noticeably decreased. At the same time, the sharp increase in purchases led to regional imbalance and stockpiling," the institute wrote in a press release.

"Medicines as simple as an anti-fever liquid are often no longer available," said Thomas Fischbach, head of the Professional Association of Pediatricians and Adolescent Doctors. "There are too few suppliers of such remedies because the fixed-price regulation in our country has led to a migration of production to low-wage countries such as India and China." There, he notes, there have also been supply chain problems, which in turn lead to supply bottlenecks.

Calls to produce more drugs in Germany

The problem is not new: At the beginning of 2022, Germany saw a dramatic shortage of tamoxifen, a drug used in the treatment of breast cancer patients. There is no substitute for this drug, and seriously ill patients need a regular supply. 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 intervened and ordered that, due to the emergency, alternative medicines containing tamoxifen may now be imported from abroad and sold without German approval. Still, tamoxifen continues to be one of the drugs in short supply.

Doctors and opposition politicians are now calling for immediate action from the German government, and experts are calling for government production of vital drugs in Germany. It's time for a rethink, they said, and production would have to be shifted back from Asia.

German Health Minister Karl Lauterbach has responded by promising to invest more in the procurement and production of medicines for children.

This article was originally written in German.

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