“We ask you to work as quickly as possible in favor of this dramatic situation”. It is a real cry of alarm that the representatives of French, German, Italian, Swiss and Austrian pediatricians have addressed to their respective ministers these days. These children’s health specialists worry about continuing shortages of medicines for their little patients. If the question had made the headlines in the heart of winter, at the time of the great epidemics of bronchiolitis and influenza, one would have hoped that, since then, a solution would have been found. This is also what the Minister of Health François Braun announced, then promising a return to normal “within two to three months”. This is not the case, and the situation has even deteriorated since then, particularly in France, while our country is facing an upsurge in streptococcal infections, worries Dr. Andreas Werner, president of the Association French outpatient pediatrics.
With colleagues from several European countries, you sent an open letter to your respective ministers of health to warn about the shortages of pediatric medicines. So there have been no improvements since this winter?
Nothing works out, quite the contrary! The only difference is that we now have monthly meetings with the National Medicines Safety Agency. But only to find that the quantities of available products are decreasing month by month. Last week we had even less medicine on the pharmacy shelves than in February. I am talking about amoxicillin, which remains our main point of concern. We continue to tinker, but it is far from ideal, especially since we are currently facing a very severe epidemic of streptococcal infections, with in particular children under three years old affected, which we saw very rarely so far. But streptococci can cause sore throats and ear infections, but also serious infections such as meningitis or septicemia. Either way, you need to be able to deal with them quickly.
I do not know what it will give if we continue to shorten the duration of treatments or to adapt the drugs normally intended for adults. Not all parents manage to give them to their children because they taste bitter and sometimes they don’t want to swallow them or they spit them out. Our patients are not being treated properly, and their health is very clearly at risk.
Added to this are cases of influenza or bronchiolitis, the epidemiology of which has been very disrupted since the pandemic. Usually in this season these viruses are gone. But they are still there, and we know that they make the bed of bacterial superinfections. We therefore still have significant needs for antibiotics, and the suppliers are not keeping up.
Is amoxicillin the only drug currently concerned?
We still see shortages of corticosteroids in the treatment of asthma attacks (oral forms) or in prevention (inhaled forms). Supplies of pediatric paracetamol also remain tight. It is of course not normal to encounter such difficulties in France in 2023, but at the limit, it is not necessarily always essential to treat the fever.
Children are not the only ones affected by tensions and stock shortages: molecules for medical abortions are also difficult to find at present. But what we find inadmissible is that our little patients represent a tiny part of the pharmaceutical expenditure and that, for all that, no one wants to invest the money necessary to guarantee their access to care.
How do you explain that these shortages persist?
Prescribing practices in France remain one of the main causes of tension over amoxicillin. We know that some doctors prescribe too many antibiotics, especially when they see children occasionally, in the context of unscheduled care.
But this shortage is global. The majority of pharmaceutical raw materials are produced in China, while pediatric syrups come mainly from India. However, in these two countries, production was greatly disrupted by the Covid. As they continue not to produce enough to meet demand, they sell to the highest bidders. As France continues to negotiate the price of drugs very strongly, it is less well served than other countries. By dint of wanting to save too much, we save on children’s health.
You said it’s a global shortage. Under these conditions, do the prices practiced in France really explain the current difficulties?
When we talk to our European colleagues, they tell us clearly that the shortages persist, but not getting worse. In our country, as I told you, the situation continues to deteriorate. Ask the pharmacists: these days, they start their long weekend shifts with three or four bottles of amoxicillin in stock. It’s quite maddening.
What solutions should be implemented?
We are already asking that governments respect the United Nations Charter of the Rights of the Child, which they have all signed. This is to ensure the best possible treatment to grow up healthy. We see that this right is not respected.
Given the budget for the necessary drugs, which is really very low compared to the adult market, it should be possible to relocate all or part of the production to Europe. It is a decision that politicians should take, but which has not yet been taken. As this is a medium-term solution, why not consider group purchases at European level until then, to at least limit competition between countries? We have been able to do this for the covid vaccines!
We are told that there are legal obstacles to these proposals. At the same time, pharmacists until now had no right to modify adult drugs in their pharmacies to adapt them to children, and yet that is what they are doing today. Legal standards can and must adapt to the reality of needs. Now it’s up to the politicians to act. In Germany, Health Minister Karl Lauterbach immediately responded to my colleagues, telling them that he was going to take action. In France, we are still awaiting an answer from François Braun.