It only costs a few cents but it is currently in short supply: saline solution has become a scarce commodity in German hospitals and pharmacies — yet it is urgently needed for operations, and irrigation and infusion procedures. According to Thomas Preis, the head of the North Rhine Chamber of Pharmacists, the situation has worsened dramatically in recent months.

"What has already been a major problem in hospitals for months is now also affecting the care of outpatients," he warned the Düsseldorf-based newspaper Rheinische Post.

The North Rhine-Westphalian Ministry of Health confirmed that there were supply bottlenecks. It said that for several months "clinics in North Rhine-Westphalia and Germany had received only 80% of their needs" and recently this had fallen to around 50%. According to the Federal Institute for Drugs and Medical Devices (BfArM), the situation will continue for months to come.

Shortages of antibiotics in particular

Germany has repeatedly been affected by shortages of medicine, particularly antibiotics and children's medications, in recent years. The consequences are severe: a survey of members of the German Professional Association of Pediatricians (BVKJ) in spring 2024 found that a around a third believed that the quality of treatment was at risk.

The survey also found that treatment was becoming more time-consuming because doctors had to check in advance which medicines were available. According to the German Pharmacists' Association (DAV) problems have already arisen for around 500 different prescription drugs.

Other EU countries are also affected by shortages. According to a 2023 survey conducted by the Pharmaceutical Group of the European Union (PGEU), the situation has worsened in several member states, including Sweden, Portugal and Spain.

Active ingredients from China and India

The causes of the shortages are complex, as is the manufacture of drugs. Whereas Germany, which boasts large pharmaceutical companies such as Bayer, BASF, Boehringer Ingelheim and BioNTech, was once regarded as the "pharmacy of the world," production now takes place all over the world. Supply chains are longer and prone to disruption.

The majority of active ingredients are now produced in China and India. Not only are wages lower there but environmental regulations are less stringent than in the EU. Mass production and monopolization have become the focus in order to make drugs more cheaply. So, a smaller number of suppliers are producing ever larger quantities.

"Whereas we used to have 10 suppliers of paracetamol syrup for fever, today there is only one main supplier left," Professor David Francas, a supply chain expert at the Worms University of Applied Sciences, explained to DW.

"We are, therefore, dependent on just a few manufacturers. And if one of them gets stuck, then the whole supply chain gets stuck," said Professor Ulrike Holzgrabe, an expert in pharmaceutical and medicinal chemistry at the University of Würzburg.

"If there are small disasters on the supply route, such as a closed harbor in Shanghai during the COVID-19 pandemic or a ship blocking the Suez Canal, then the goods don't get to us," she told DW.

Just-in-time production does not help

Limited stocks and just-in-time production only exacerbate the problem when temporary shortages in the production chain cannot be compensated. But experts believe that restocking is expensive. Storage facilities cost money and it is never certain whether stored medicines will actually be sold.

Fluctuations in demand are enormous: during the COVID-19 pandemic, for example, demand at Infectopharm collapsed because the widespread wearing of masks led to a sharp decline in several other infectious diseases. The company had to destroy expensive antibiotic juices for children because it was unable to sell them. Two years later, demand soared again.

The price problem is particularly acute with generics, which account for 70 to 80% of the basic supply of pharmaceuticals. "The margins for manufacturing such products are extremely low," said Holzgrabe. Manufacturers are forced to produce as cheaply as possible by discount agreements and other deals that were introduced into the German healthcare system years ago.

Though many have called for this, it would be difficult to bring production back to the EU completely. One reason is that it would be complicated to produce the fine chemicals needed for active ingredients. "We have created environmental legislation that makes this almost impossible," said Holzgrabe.

Even if it were possible, it would not provide a solution for this coming winter. "It takes at least five years to re-establish production facilities," said Francas.

This article was translated from German.

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