They scoured the country, looking for answers. In a report of approximately 400 pages, the result of multiple interviews with the governments of the last decades, industrialists and health institutions, the members of the Senate Inquiry Commission on drug shortages delivered their verdict on Thursday, July 6 on the causes of the absence of certain treatments in the drawers of French pharmacies. Price, political responsibility, transparency, and European action, its president, Sonia de la Provôté, centrist senator and former doctor, delivers her analysis to L’Express.
L’Express: Problem of communication, management of institutions, lack of foresight, lack of responsiveness… The report does not spare the various past and present governments. Do they have their share of responsibility?
Sonia de la Provôté: Ministers are not responsible for everything. And the problem is very complex. But it has not been taken into account firmly enough by the public authorities. We locked ourselves in a form of denial, and we are now discovering its magnitude. However, the situation did not deteriorate overnight. In 2022, approximately 3,500 stockouts were reported to the National Medicines Safety Agency (ANSM). In 2018, we were already at 900! At the time, the Senate had already launched a fact-finding mission. Many of our current proposals have actually already been put on the table.
On communication, what is the problem?
Take amoxicillin for example. In November, the Minister of Health assured that the antibiotic would be back in pharmacies in a few weeks. In January 2023, it was even a matter of a fortnight. We are in June, the drugstore drawers are still empty. We were also told that there was no shortage of abortion pills, even though some women could no longer find any in their department. And we had to have a list of essential medicines, it arrived late and without being backed by a stock obligation, contrary to what had been said. Examples like this are numerous. The government is entangled in contradictory communication. You can’t promise without being in a position to ensure that your word will be followed up. We are talking about health issues anyway! On these subjects, we need clear, transparent and consistent speech. Let’s stop with the elements of com’.
The report draws attention to the IT systems of drug players. They should help assess inventory. But everyone has their own, and none are interoperable… Shortages, again the fault of the bureaucracy?
Not only, of course. But it is an important subject. The monitoring of the availability of drugs essentially goes through these platforms. But too often the data is bad, and slow to arrive. It is absolutely necessary to generalize a few reliable and complementary tools and to cut into the rest, in order to obtain information in real time, open to all, which is not the case today. Doctors are often the last to know, which feeds a climate of anxiety and general mistrust.
In addition to being sometimes too complicated, the system lacks transparency. We need to know the shortcomings, but also the real constraints and costs of companies, what they do with the tax credits granted to them. Take the list of essential medicines that the government has created, much criticized by specialists. How was it made? On what criteria? We do not know anything. The drug is not a consumer good like the others. We need clear rules and complete information.
You also highlight a very large number of health committees and agencies, a French specificity…
I call that comitology! Committees, lots of committees. I discover them every day, and yet I am a doctor. Without blaming them, because they are doing a tremendous job, there are a lot of contacts on the drug. It was necessary to create a vaccine committee, during the Covid-19, coupled with a task force. The existing committees weren’t working? We do not need more cenacles, but more political steering. This is one of the key points of the report.
On the political steering, the takeover must first be European?
We advocate a true “Europe of Health”. At 27, we are stronger. We have seen it with the Covid-19. The European Union has secured supplies of vaccines and medical devices. We have to coordinate. In reindustrialisation, in particular, because not everything will be produced in France, it will therefore be necessary to distribute the production sites. And in inventory management, too, to prevent one country from being in surplus when another is lacking. This requires a great harmonization. Harmonization of packaging and labeling rules, for example, but also instructions given to manufacturers on the stocks they must keep and the information they must transmit.
Last February, the Minister of Health agreed to increase the price of certain generic drugs, provided that manufacturers obey certain rules. Is it an important lever, the price?
Yes, this is in line with one of our proposals. Some mature drugs, that is, drugs that have been on the market for a long time, are bought too low. This pushes manufacturers to sell to others. It is necessary to pay more for the most essential, while conditioning these efforts on better securing of supplies. Remember that it is not because a drug is old that it has no therapeutic interest. Some are essential and have no alternatives. It is on them that we must let go, and not everywhere. But we must also change the rules of public procurement. Today, calls for tender favor the least expensive suppliers. If we continue like this, we will end up with companies that manufacture in France, but sell abroad.
Some would also like to play on expiry dates, in case of emergency…
It is a subject, to glean availability. The American drug agency (FDA) did. There is a bit of a systematism in the way expiration dates are set. Sometimes they do not take into account the effects of conditioning. A powder does not expire as quickly as a capsule or a liquid. I am not able to decide from a health point of view. But it is also necessary to leave space, punctually. There are also a lot of drugs that sit in patient cupboards. We could also unpack, and deliver only the necessary stamps. But these are only emergency solutions, as you say.