Empty shelf for every third pill: Switzerland is almost out of medicine

Enea Martinelli stands in front of a rack full of medicines. He’s reaching specifically for a package. Marcoumar, a blood thinner. The chief pharmacist of Interlaken Hospital can tell a story like any other parcel here in his kingdom. Although it is not primarily about the effect of the medication. They are the birth stories, or rather the sticking points, that will soon appear with every third commonly used medication.

Martinelli is the only person in Switzerland who has a comprehensive overview. He has been counting supply and supply bottlenecks for eight years. And it’s no secret that the problems are increasing: its website drugshortage.ch currently lists 948 supply bottlenecks. The list gets longer every week. It includes tranquilizers and sleeping pills such as Temesta, antibiotics, painkillers, diabetes medications, and blood pressure lowering medications.

Marcoumar, the blood thinner, is not listed. Not yet. But for Martinelli it is a matter of time. The drug, which is used to prevent thrombosis and embolism, is used by about 50,000 patients in Switzerland and is also used in hospitals. Only: the 100-pack is no longer available. All pharmacists are therefore switching to the 25-pack, which is already in short supply.

The next step is clear: within a few weeks there will be a switch to another therapy, to Noak (new oral anticoagulants). That is why 50,000 people will soon have to go to the doctor to adjust their medication and have laboratory values ​​drawn up. That alone will cost several million francs.

At the same time, drug costs inevitably rise. A Marcoumar day therapy costs about 10 cents, Martinelli calculates. Switching to Noak means a surcharge of 25x. Day therapy now costs about 250 cents per patient. Extrapolated over a year, this amounts to additional costs of more than 43 million francs – just for the active ingredient.

The calculation is theoretical. Because no one knows if and when the medicine will be available again and whether it can ever be delivered again.

And that is precisely the core of the problem: there is no official body in Switzerland that anticipates possible bottlenecks in order to address them in a timely manner, investigate alternatives and, if necessary, also discuss with foreign neighbors how the problem can be solved. Martinelli maintains his list of defects on his own initiative. He says: “The fact that this has to be done privately is an indictment on our country.”

The fact that a medicine cannot be supplied is not a new phenomenon. Martinelli says: “We also had bottlenecks twenty years ago.” The cadence is new. Since Corona, there have been more and more cases of interruptions in the supply chain: sometimes a part for the production of a medicine is missing. Sometimes production stops. Or China decides to stop exporting medicines.

This means an enormous effort for hospital pharmacies. Twenty years ago, Martinelli’s team in Interlaken had to look for replacement medicines four times a year, but today this happens several times a day.

There is currently a lack of tetanus vaccinations in the Frutigen, Meiringen, Interlaken (FMI) hospital network this morning. Anyone who comes to the hospital with a wound will receive such a vaccination to prevent tetanus. This is standard. Normally, the hospital serving the tourist region of the Bernese Oberland needs thirty to forty people per weekend. But for major events such as the Unspunnen Festival, the hospital must be prepared. Pharmacy assistant Marianne Gehrig had ordered 150 doses. But they didn’t arrive today either. “Our supplies last all weekend,” she says. “Then we’ll see.” Martinelli adds comfortingly: “When it rains, there are at least fewer motorcyclists on the road.”

Enea Martinelli has dedicated his life to providing medicine. When he was young, he was president of the association of hospital pharmacists. Even then, supply bottlenecks were one of the concerns of his work. He fought for changes to the Therapeutic Products Act in 2010, allowing imports from abroad for the first time. “Previously, we had to submit an application for every patient who needed a medicine. That was an absurd amount of effort for a problem that was easily solved.”

So it’s not like nothing political has happened since then. Arranging a replacement product is now easier, also because Martinelli has good contacts abroad. But supply bottlenecks are often not limited to one country. The problem is global, as the example of tuberculosis shows: there is still a single antibiotic against the infection, manufactured in South Korea. The inspections revealed quality problems in production and the company wanted to close the factory. To prevent this, the pharmaceutical world now accepts lower quality products as a compromise.

Martinelli explains that there is hardly any innovation in the field of medicines for common diseases. “The drugs don’t cost anything anymore, so there is no interest in researching them further, let alone producing them.”

There are no easy solutions to this problem. As a first step, Martinelli demands that the federal government finally recognize the bottlenecks as a problem. This means, for example, that Switzerland makes its own assessment of the supply situation. The Federal Office for the Economic Supply of the State maintains its own list. However, it only helps to a limited extent because it lists the active ingredients very selectively.

Relying solely on the WHO list of missing ‘essential medicines’ doesn’t work either. For example, the Marcoumar mentioned at the beginning is not on the WHO shortage list because another preparation from the same class is used much more often worldwide. But in Switzerland this is not allowed. Official Switzerland has not yet recognized the impending Marcoumar shortage.

“Switzerland needs an official list that warns of bottlenecks and points to alternatives.” Contact with the manufacturers and some early warning are important. For example, if a pharmaceutical company decides to stop producing an important drug, this can be anticipated. Especially when there is no money to be made with products whose patent has expired, manufacturers lose interest in production or approval for the small Swiss market.

Then it is important to find a solution with the company that is good for both parties. Because Martinelli says, “We can’t force any company to produce a drug at a loss.” He knows that such statements give him the reputation of being a disguised representative of the pharmaceutical industry. Martinelli rejects this out of hand: “I only have my patients in my head.” As soon as a medicine is missing, they can no longer be treated optimally. It is a fact that not everyone wants to hear: “In the dispute over drug prices, pharmaceutical products have the upper hand, therefore a counter concept is needed.”

It is critical to seek solutions before patients are harmed. But without a concept, that’s exactly what happens. That is why many pharmacists and doctors feel abandoned, despite the understandable price pressure on medicines.

There are ideas. In France, for example, President Emmanuel Macron has declared 50 medicines essential and ordered them to be produced in the country. Belgium regulates the production of important medicines: production companies can propose prices at which they want to produce the medicine.

Switzerland has no such industrial policy. But even better international coordination could bring progress. However, dependence on foreign countries also has its downside: in a crisis, every country is closest to itself. Given the unstable global political situation, dependence on supply chains and the disappearance of production facilities, the supply of medicines is increasingly becoming a matter of national security.

Enea Martinelli now stands in front of a rack in the corner of the basement that contains all the imported drugs that are no longer approved in Switzerland and generally have to be imported. A drug against panic attacks (doxepin), against heart failure (digoxin), against hyperthyroidism (sodium perchlorate), phosphate deficiency (sodium phosphate), active ingredients that have been helping people for years, disappear from the market. It is to despair.

But, and this is probably also a reason why it is so difficult to understand the situation: inventorying the available and missing medicines is not that easy, says Martinelli. If the manufacturer reports problems, the wholesaler or pharmacy can still have the product in stock without creating a shortage. At the same time, pharmacies tend to hoard medications that are in short supply. For Martinelli, the behavior is explainable. “Everyone has their patients and their care in mind.” Patient safety is the first priority. “Then every pharmacist becomes an egoist.”

There is another reason why the idea that hospitals, for example, act as a buffer in the supply of medicine does not work. The needs of patients in pharmacies and hospitals are completely different. Basic care medicines are also available in the hospital, but to a limited extent because patients are usually only there for a short time.

There is not always replacement, which can lead to conflict. There is currently a lack of anesthesia for shoulder surgery. There are other means, but thanks to the proven method, the patient can move the arm again shortly after the operation. This also has an impact on the work of the anesthesiologist. Patients wait longer until they can move their arm again. The understanding of why another anesthetic should be substituted quickly disappears.

There is no reason to panic for the time being. The reality is often: there is another way, but it’s just not the best way. (aargauerzeitung.ch)