No more paracetamol or amoxicillin shortages? To prevent the drugs from missing, the production of fifty of them will be relocated to France, including 25 in the coming weeks, Emmanuel Macron announced on Tuesday. The government has also unveiled a list of 450 so-called “essential” drugs, for which manufacturers will in particular be required to keep the equivalent of 4 months of stock. Salutary announcements, but incomplete according to Bruno Bonnemain, president of the Academy of Pharmacy.
L’Express: The Academy of Pharmacy has long pushed for the creation of this list. Are you satisfied ?
Bruno Bonnemain: These are important announcements. We could not tackle head-on the 3000 molecules in tension that the government identified this winter. The development of a list, which we have been requesting for five years, makes it possible to prioritize national efforts. This will also form a basis for discussion at European level, where a similar list is being produced. But we have to look further, otherwise new shortages will occur next winter.
Relocating 25 drugs in the coming weeks, and 50 in total, doesn’t that go far enough?
Relocating is great, but the timing seems a bit optimistic to me. Ten years ago, France was one of the leading producers in the world. Today, we are 80% dependent on foreign countries. While a number of French industrial sites still in service can ramp up, this is not going to happen all at once. The United States started ten years ago, and have still not come to the end of their shortages. And we’re not going to relocate everything.
What should be done then?
The question of prices is central. It hasn’t been discussed enough. A significant part of the shortages in France is due to purchase prices that are too low compared to other European countries. In the event of tension, manufacturers tend to sell to the highest bidder. France is therefore often served last. Raising prices, when necessary, on a set of products, would restore this attractiveness. The Germans, Spaniards, and Portuguese did. Why not us ?
Relocation must be accompanied by a great reflection on prices. In reality, one does not go without the other. Some French manufacturers have seen their tenders rejected by 1 cent, for foreign companies, because they were too expensive. And certain molecules produced in France will be stopped by Sanofi because their margin is too low. If what we produce in France cannot be marketed in our country, it is not worth it. Just as it would be necessary, in the long term, that the calls for hospital tenders prioritize their purchases in France and in Europe.
Then, more emphasis should also have been placed on coordination. At the national level, first. Too often, the various French ministries step on each other’s toes. It is imperative to have a global drug policy, managed at the highest level of the State. Otherwise, we end up with contradictory situations. In the latest social security finance bill, it is written that old, essential molecules, such as paracetamol, must be preserved. And later it is also written that these same products will be taxed, when they are already not profitable. It’s necessary to choose !
Has the European response to shortages been addressed enough in your opinion?
This is part of the coordination effort that we have to make if we want to solve the shortages. It is quite rare for all countries to be out of order at the same time. If we think at the European level, we could direct the factors of production, and the orders, according to the immediate needs.
We often talk about the miracle Civica in the United States. A consortium of American hospitals that have launched their own laboratory. Why don’t we do the same?
Civica has done very well in the United States, but this economic model is difficult to import into France, and more broadly into Europe. The consortium asks that its customers supply 50% from them, for each type of product. The European logic of calls for tenders would not allow such contracts. It would then be necessary to modify the legislation, a question which would have to be settled at 27, at European level. And the prices charged by Civica are relatively high. Private hospitals buy.
Will it not be complicated to relocate, while respecting our environmental and climate objectives?
It’s a challenge. An example. Today, apart from a manufacturer in Austria, no European company produces the precursor of antibiotics, the molecule which makes it possible to manufacture them. All this synthesis, very polluting, is made in China. Ideally, all manufacturing of the drug should be relocated. If we do the last transformation in France, but our raw materials all come from China, it is useless. But it also requires making sure you can do it without risk to the environment. Cleaner processes exist. But that requires investment, research. And therefore means.