EU faced penicillin, amoxicillin, paracetamol shortages Dec 2022-Jan 2023.

EU manufacturing relies on China/India active ingredients.

France had 4,925 drug shortages in 2023, including oncology.

Greece has over 200 drugs in permanent shortage due to parallel exports.

Taiwan's community pharmacies unable to supply drugs in 2023.

Taiwan established real‑time alerts for drug shortages.

US had 323 drugs in severe shortage Q1 2024.

US cancer centers short on carboplatin, cisplatin, methotrexate, 5‑FU, fludarabine, hydrocortisone.

US pharmacies 66% lack amoxicillin, 89% lack Adderall.

Canada faces acetaminophen, ibuprofen shortages due to raw ingredients.

Egypt insulin shortages caused by raw material import issues.

Egypt shortages of heart, bone, cancer, joint, epilepsy, hypertension, thyroid, diabetes drugs.

Saudi Arabia reported 1,372 missing drugs, raw material shortages.

Tunisia lost 500, Egypt 1,000, Turkey 2,000 drug items.

US FDA requires manufacturers to report production disruptions 6 months early.

US proposes $3.26‑5.11bn over 10 years to address shortages.

EU Commission proposes solidarity mechanism, early warning, joint procurement.

Taiwan 2024 DET policy will adjust drug prices amid war, inflation.

Greece patients search multiple pharmacies or stop treatment due to shortages.

Israeli bombardment in Rafah closed pharmacies, diverted drugs to soldiers.

EU faced penicillin, amoxicillin, paracetamol shortages Dec 2022-Jan 2023.

Title:

Content: Brussels is planning for EU countries to share vital medicines and take emergency measures to avoid a repeat of shortages that hit the bloc a year ago.

The European Commission is proposing a “voluntary solidarity mechanism” requested by France and Germany and an early warning system flagging when drugs become scarce, according to draft proposals seen by the Financial Times. If insufficient donors come forward, EU capitals will be allowed to tap into an EU-funded stockpile set up during the Covid-19 pandemic and take other emergency measures.

In December and January western countries suffered a shortage of antibiotics including penicillin and amoxicillin, and painkillers such as paracetamol, especially in medicines used by children.

Among the emergency measures floated to prevent a repeat of that crisis, the commission could allow the extension of a drug’s shelf life, fast track approvals of alternative suppliers and support production increases.

Brussels will also encourage joint procurement of drugs from 2024 and medicine swaps with countries in the southern hemisphere, where peak winter demand happens at a different time.

The commission will draw up guidance for national stockpiles in 2024 and establish a Critical Medicines Alliance bringing governments, industry and civil society together. The commission declined to comment.

Three-quarters of countries reported a worsening of drug shortages in 2022, according to an industry survey. EU manufacturing is heavily reliant on imported active pharmaceutical ingredients from China and India.

Rising demand and disruption to supply chains have been compounded by inflation hitting the production of generic drugs, which typically sell at much lower prices than branded versions.

France has been actively encouraging the reshoring of basic medicine supply, with a giant paracetamol factory set to open in the country next year.

The EU is discussing whether to provide more funding for domestic production.

The commission’s proposal is scheduled to be approved on October 25 and could still change. Initially non-binding, it could lead to a Critical Medicines Act, with Brussels drawing up a list of vital medicines by year-end.

The commission also urges member states and the European parliament to approve its overhaul of pharmaceutical legislation, put forward in April. It includes plans to take control of drug production in the event of a public health emergency, a requirement for stockholders to inform Brussels of supply levels and for manufacturers to give early warnings of shortages.

An analysis by the European Medicines Agency and the commission found that unless there is unexpected demand the EU should avoid an antibiotics shortage this year.

“The information available today suggests that — if demand in the coming winter season does not differ significantly from the demand of recent years — the supply to the EU of key antibiotics seems to generally match demand,” the analysis said.

“However, this depends strongly on the compliance of industry with their legal obligations to ensure supply and their ability to adapt.”

Copyright The Financial Times Limited 2023. All rights reserved.
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EU manufacturing relies on China/India active ingredients.

France had 4,925 drug shortages in 2023, including oncology.

Title:

Content: French health groups put forward proposals to limit the damage of worsening drug shortages

Medicines such as cough syrup, lozenges and ointment are seen on a table in an apartment in Berlin, Tuesday, December 20, 2022. Copyright Stephanie Pilick/dpa via AP
Copyright Stephanie Pilick/dpa via AP
By Lauren Chadwick
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Pharmaceutical companies’ lack of transparency leads to rising drug prices and less control over public resources, the group of health organisations say.

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A group of French organisations have called for more transparency from pharmaceutical companies as drug shortages increase.

In a joint report, 14 civil society organisations outlined their recommendations to solve a “situation that has only worsened” since 2018.

The French medicines regulator signalled 4,925 drug shortages in 2023, compared to 3,761 in 2022 and 2,160 in 2021.

A 2024 survey from France Assos Santé, which represents patients, found that 44 per cent of people in France said they had faced a drug shortage this year.

One of the pharmacy unions in France has even planned a strike at the end of the month over drug shortages and what they say is worsening access to care.

Each health organisation contributed an article with recommendations for dealing with the drug shortages.

The League Against Cancer urged complete transparency on drug shortages and potential substitutions for health professionals.

They also called for monitoring of medicine stocks and their location in the country to guarantee equal access.

The organisation found in a survey published in February that 78 per cent of health professionals in oncology had been faced with a drug shortage.

Drug shortages or delays have led to anxiety among cancer patients, lost time, and worsening symptoms, the organisation said.

France Assos Santé, meanwhile, wrote that an urgent response should not be to support “the industrial sector which bears serious responsibilities” for abandoning the production of less profitable drugs, relocating drug production, and keeping insufficient medicine stocks.

They would like any cost increases justified by production costs or the risk of withdrawing a drug from the market due to it being unprofitable. They called for cost evaluations to be made public.

Their concerns also range from the use of public money to bring drug production to Europe to new government plans to prevent shortages.

Some changes at the EU level criticised

Last year, the European Commission announced several measures to reform the pharmaceutical industry and address critical drug shortages.

The European Parliament went on to adopt a position on pharmaceutical reform last month, that included “incentives for innovation” and an effort to limit overuse of antibiotics.

The non-profit organisation Prescrire, which focuses on information about medicine, wrote in a chapter they contributed to the report that while some of the European Commission’s measures were welcome, others were concerning.

One of the many measures they rejected included the Commission’s proposal to reduce the number of days of scientific evaluation of drugs from 210 to 180, which they said was necessary time rather than an “administrative obstacle”.

While the NGO welcomed some measures such as government drug shortage prevention plans, it said the Commission should allow EU states to require pharmaceutical companies to have safety stocks of medicine and sanction those that do not respect them.

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French consumer organisation UFC-Que Choisir and the European Consumer Organisation (BEUC) said that they had hoped MEPs would shorten the length of time for “data protection” to allow generic medicines to be marketed more quickly.

Instead, MEPs approved shortening the period to 7.5 years, “which is almost the same duration as the current 8 years [yet] within the framework of the text adopted by Parliament, companies can gain additional months of protection under certain conditions to reach a total of 8.5 years,” UFC-Que Choisir said.

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Greece has over 200 drugs in permanent shortage due to parallel exports.

Title:

Content: General Supervision
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Warnings: A new wave of "Corona" in the coming weeks
Marco Cavalieri, head of vaccine strategy at the European Medicines Agency (EMA), warned on Wednesday of a new wave of coronavirus cases, mostly with new subvariants of the Omicron mutant, in the coming weeks.
The head of the European Medicines Agency ’ s vaccine strategy said: “The epidemic is not over yet.
The Omicron PQ1 variant was identified in at least five European countries last week.
The European Centre for Disease Prevention and Control predicts that the closely related variant BQ1 and BQ1.1 will become the dominant strains from mid-November to early December.
According to the Greek newspaper Kathmirini, on its website.
"It is not yet known whether it is more transmissible or causes a more serious disease than variants BA4 and BA5, but what is known is that it has a greater ability to escape immunity given by vaccination, covid-virus infection, or antibodies.
Greek authorities on Tuesday reported 52,966 confirmed cases of the coronavirus from October 17 to 23, and the National Public Health Organization reported 138 deaths related to the virus during the same period.
The Athens Association of Greek Pharmacists announced today that the country is suffering from a serious shortage of medicines, with no more than 400 essential medicines available, and patients and pharmacists are struggling to adapt.
The Athens Pharmaceutical Society said in a statement: "The shortage is related to essential drugs such as antibiotics, antidiabetics, antiepileptics, anticoagulants, antidepressants and others."
According to the Greek newspaper Kathmirini, in its English-language version.
Dr. Apostolos Valtas, President of the Pharmaceutical Society, said: “Over the past month, I have been looking in pharmacies for a specific muscle relaxant that the patient needs to treat spasticity, the patient is bedridden after a serious accident and needs chronic treatment for spasticity.
The treatment required eight injections and I found only one. ”
“It ’ s an uncontrollable daily problem for pharmacies and patients who have to search from pharmacy to pharmacy for the products their doctor prescribes, or even stop treatment until they find their medicines. ”
According to pharmacists, there are more than 200 drugs for almost the entire range of diseases in a state of permanent shortage.
The President of the Pharmaceutical Society explained that the main reason cited by pharmacists for the shortage of medicines is the continuous increase in parallel exports, noting that Greece has the lowest prices of medicines in the European Union, which makes their export very profitable for drug distributors.

Taiwan's community pharmacies unable to supply drugs in 2023.

Title:

Content: Policy and Inadequate Clinical Engagement Call on Government to Address Drug Deficiency and Enhance Patient Participation Rights
Health Care Network
The World Health Organization (WHO) has designated September 17 every year as World Patient Safety Day (referred to as Patient Safety Day), but patient participation in China is still insufficient from policy to clinical.
The Taiwan Alliance of Patients and Friends (TAPO) today (13th) invited patient groups and medical organizations to celebrate World Patient Safety Day, calling on the government to actively address the crisis of drug shortage and implement three important rights of patients in the medical and health care system: the right to know, the right to choose and the right to participate.
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The Taiwan Alliance of Patients and Friends (TAPO) held a press conference on World Patient Safety Day 2023 on the 13th, inviting the two major competent authorities of the Ministry of Health and Welfare, the Ministry of Health and Welfare, the Ministry of Health and Welfare, the Department of Health, the Association of Pharmacists, the Association of Nurses, the Medical Reform Foundation, and the Pharmaceutical Relief Foundation to jointly advocate for patient safety.
Call on the Ministry of Health and Welfare to actively respond to the drug shortage crisis
Wu Honglai, president of TAPO, pointed out that a stable supply of drugs is the basis of drug safety. At the beginning of this year, the shortage of drugs in China worsened, and the public may not be able to obtain the required drugs in community pharmacies.
The Ministry of Health and Welfare subsequently set up a drug supply notification processing center, but the problem of drug shortage at the grassroots level is still reported.
Now the global shortage of drugs continues to fever, the United States official also confirmed that the lack of drugs for several months, in addition to pain medication, even cancer drugs, antibiotics are in crisis.
Faced with such a challenge, Taiwan is also a small market, low health insurance cost of the country, I am afraid that it will be no small impact, imploring the Ministry of Health and Welfare to put forward a more positive response to the shortage of drugs, so that patients will not suffer from the interruption of treatment.
Chen Wen-wen, CEO of the Drug Harm Relief Foundation, believes that "drug safety" is an important part of maintaining patient safety. From years of experience and research, many serious drug hazards can be prevented beforehand. In all stages of treatment, such as receiving prescriptions, taking drugs, and tracking the effectiveness of treatment, you must have a deep understanding of the relevant information in order to escape the passive acceptance of instructions and actively restore health.
Enhance patient participation and influence
Yan Biwen, deputy executive director of the Cancer Hope Foundation, suggested that the current time point for patients to express their views is worth discussing again, and the expert meeting has completed the drug payment proposal before the expression, for discussion by the Joint Committee, and the views of patients are difficult to exert practical impact.
The government should refer to the practices of leading countries such as the United Kingdom, Australia and Canada to include the views of patients in the medical technology assessment, including subsequent expert meetings and meetings to decide on payment, and have formal representatives of patients to participate in the discussion and resolution.
This year, the Health Insurance Department visited the Cancer New Drug Fund of the United Kingdom and cooperated with NICE in the United Kingdom. It should also follow its patient-centered spirit, enhance the participation of patients and expand the scope and influence of collecting opinions.
“Healthcare is not just about treating diseases, it ’ s about caring for and protecting lives, ” said Su Yuyi, deputy general secretary of the All Union of Physicians. Since 105, doctors have been promoting shared decision-making. Instead, they discuss treatment options, risks and benefits with patients to help them make decisions that meet their values, preferences and goals.
Cai Li-chuan, deputy executive director of the Taiwan Cancer Fund, believes that at present, the participation of patients' representatives in the important decision-making meeting of health insurance is still insufficient. In the "joint drafting" meeting to decide whether drugs should be included in the health insurance payment, there are only two patients present, and informal representatives, there is still a gap in the exercise of the rights of the meeting. Members who have obtained seats by drawing lots, so that the voices of patients are easily ignored.
Competent authorities should plan a more stable and sound system for patient participation, and pay attention to the voice of patients.
Patient safety should be ensured by maintaining a stable ratio of care
According to a study by Linda Aiken, a professor at the School of Nursing at the University of Pennsylvania, the probability of death of surgical patients within 30 days of admission increases by 7%.
Source: Healthnews.com https: / / www.healthnews.com.tw / readnews.php? id = 59248
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Taiwan established real‑time alerts for drug shortages.

Title:

Content: The lack of medicine continues to burn!
The Ministry of Health and Welfare has proposed a short, medium and long-term strategy to deal with the current 5 coping mechanisms.
Journalist Yen Zhenzhen / Taipei Report
According to the Ministry of Health and Welfare, the shortage of drugs is not a single factor, but includes supply problems, manufacturing problems, clinical demand factors, uneven distribution of drugs, drug use habits and drug prices. In addition to dealing with the relatively high clinical demand items, it is properly allocated to all levels of medical institutions and pharmacies to fully meet the needs of clinical end-use drugs.
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In the face of the shortage of drugs, Wang said, the existing health insurance uses five major coping mechanisms, including 1, a single processing window, a dedicated person to help deal with the problem of drug purchase, and contact the Food and Drug Administration to put relevant information on the website of the NHI. (4) Drug price adjustment mechanism that does not meet the cost can be re-checked according to the way of raising the price of special drugs; (5) Alternative drugs can still declare the cost, if they are not irreplaceable, they can be replaced at the same price or lower than the original prescription drug price.
In addition, Wang pointed out that in the face of the international epidemic, the Russian-Ukrainian war, and labor shortage, drug shortage is a problem facing all countries. In order to strengthen the stable supply mechanism of drugs in China, the Ministry of Health and Welfare continues to actively respond to the short-term strategy to solve the problem of drug shortage. The Food and Drug Administration (FDA) and the pharmaceutical industry have made every effort to actively arrange production lines, strive for early import, increase production / import quantity, and properly distribute to all levels of medical institutions and pharmacies to fully meet the demand for clinical end use drugs.
In addition, to properly handle the issue of drug price adjustment, the Central Health Insurance Administration of the Ministry of Health and Welfare intends to implement the "Universal Health Insurance Cost Distribution Target System (DET)" in April this year, which will adjust the number of drug prices and adjust the quota in a suitable manner, taking into account factors such as the epidemic, the Russian-Ukrainian war and inflation.
In terms of medium-term strategy, Wang said that he will establish a permanent drug shortage treatment center and optimize drug supply information transmission.
In order to speed up the handling of drug shortage incidents, we will adopt dedicated personnel and cross-departmental cooperation to develop drug shortage prevention policies to prevent drug shortage in advance, strengthen cross-departmental data integration and proactive monitoring to detect drug shortage incidents at an early stage, and intervene early through cross-departmental cooperation to stabilize drug supply.
At the same time, the Food and Drug Administration (FDA) continues to disseminate drug supply and alternative drug information through various channels. In addition to posting on the “Drug Supply Information Platform ”, the FDA will notify medical institutions and pharmacies through VPN, and weekly letters to relevant medical associations and public associations to inform members. Management system.
In the long-term strategy section, it includes reviewing the current health insurance drug pricing policy and encouraging the production of domestically manufactured generic drugs.
Wang Bi-sheng pointed out that in the review of the current health insurance drug price policy, including the development of the price protection of indicative drugs, drug price review for the lack of drugs; start the review of drug expenditure target (DET), plan the establishment of a risk control mechanism, plan the national unified procurement trial plan; comprehensively review the health insurance drug price policy, give an appropriate price protection mechanism for necessary drugs, and also target the patent period. To encourage the production of domestic manufacturers to ensure that when there is a shortage of original pharmaceutical products, there are domestic famous drugs to respond.
Wang also stressed that the Food and Drug Administration has set up a "Drug Supply Information Platform" (https: / / dsms.fda.gov.tw /), reporting hotline (02) 27878249. If medical institutions and pharmacies have any shortage of drugs, they can go to the platform for enquiry or notification, and the department will deal with it immediately.
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US had 323 drugs in severe shortage Q1 2024.

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Content: General Supervision
Elham Aboul Fath
Editor-in-Chief
Thank you for your patience.
General Supervision
Elham Aboul Fath
Editor-in-Chief
Thank you for your patience.
An Unexpected Catastrophe in the World ’ s Largest Country: The Complete Story of U.S. Drug Shortages
The deficit is at a record level.
According to data from the American Society of Health System Pharmacists and the University of Utah Drug Information Service, organizations began tracking drug shortages for the first time in 2001. Steady since 2021 – now reaching a record high of 323 drugs in the first three months of 2024.
Paul Abramowitz, CEO of the American Society of Health System Pharmacists, wrote in a blog post on Thursday: “It ’ s been a long time to end drug shortages, ” and wrote:“ All drug classes are vulnerable to shortages, some of the most worrisome shortages include sterile injectable generic drugs, including cancer chemotherapy drugs and emergency drugs stored in hospital vans and procedural areas. It is dangerous for doctors and patients. ”
In addition to the 32 chemotherapy drugs that are deficient, the five categories of drugs with the greatest deficiency include central nervous system stimulants, antimicrobials, hormonal agents, and intravenous fluids. [1] The Drug Deficiency Database maintained by the American Society of Health System Pharmacists and the University of Utah is based on voluntary reports from practitioners, patients, and others that have been confirmed by manufacturers. The U.S. drug is in short supply, because it captures broader effects on service providers and patients.
The crisis has lasted a year and a half.
More than half of the treatment shortages have lasted for more than two years, according to an analysis by health consultancy IQVIA, and the average shortage affects at least half a million patients, many of them elderly, according to the US Office of Health and Human Services under the Assistant Secretary for Planning and Evaluation, which shared its analysis with Congress in May.
Growing demand can play a role in drug shortages, as with the recent shortage of weight-loss drugs, but often manufacturing and quality problems, such as supply chain gaps and downtime, are the root cause. And varied.
But the American Society of Health System Pharmacists has “serious concerns ” about parts of this proposal, especially financial sanctions imposed on hospitals that lack the resources to comply with the recommendations, Abramowitz wrote:“ We all know that managing shortages is not enough and is not a sustainable solution to the worsening crisis, and there is still a lot of work to be done at the federal level to fix the root causes of drug shortages. ”
Why Shortage Occurs
Shortages can be caused by high demand, as with the recent shortage of weight-loss drugs, but this is not usually the main problem.
The FDA also blames manufacturing and quality problems, supply chain gaps, and downtime, and Dr. Emily Tucker, a drug shortage expert and an assistant professor of industrial engineering at Clemson University, says that when there is an indication of shortages, large health systems often also proactively place large orders, adding to the system ’ s stress.
“I don ’ t blame anyone.
“When I talk to all the stakeholders – whether it ’ s wholesalers, manufacturers, or the government – everyone wants this problem to end, ” she said.
Lack of transparency
Dr. Julie Grallo, chief medical officer and executive vice president of the American Society of Clinical Oncology, told the House Committee earlier that the shortage puts providers in a terrible position: “The drug shortage crisis is forcing providers to make impossible choices, and it is also hindering the development of new drugs. Health drugs are purchased only on a price basis, and manufacturers do not have to disclose the source of their acquisition of the ingredients.
The shortage of this generic chemical drug came due to the closure of one factory in India that manufactures the active ingredient after a surprise FDA inspection found “significant quality issues, ” says Jarallo:“ We didn ’ t know, and there was no transparency regarding the company ’ s supply of the majority of active pharmaceutical ingredients to all manufacturers across the board.
Knowing this in advance, we could have responded much faster, ” Dr. Steven Schundlemeyer, director of the PRIME Institute of the University of Minnesota School of Pharmacy, which focuses on economic and management issues, told the committee that as with defense contractors in the United States, New Zealand requires manufacturers to disclose their suppliers, and that information is required.
Easily accessible in the database.
Related Topics

Title:

Content: Meitu
The first quarter of the United States serious drug shortage 323 drugs urgent cancer patients also have to be diverted and rationed!
CHU HENG NETWORK NEWS CENTER 2024-04-16 10: 42
According to the latest data from the American Society of Health System Pharmacists (ASHP) and the Utah Center for Drug Information Services, a total of 323 drugs in the United States were in severe shortages in the first quarter of this year, surpassing the record of 320 in 2014.
Among the drugs affected are the widely used diabetes drugs Ozempic and Mounjaro, the allergy treatment drug adrenaline, the common antibiotic amoxicillin for children, chemotherapy drugs and injections commonly used in hospitals in intensive care.
ASHP CEO Paul Abramowitz said in a statement that almost all categories of drugs are facing shortages, with non-patented sterile injectable drugs, including cancer chemotherapy drugs, and emergency drugs stored in hospital emergency vans and operating areas, the shortage of such drugs is the most worrying.
According to the American Cancer Society, chemotherapy is one of the top five drugs most affected by the shortage, which threatens to have a devastating impact on patients, and some hospitals and clinics say doctors have had to divert patients to ration their medications because of a shortage of some chemotherapy drugs.
In addition, ASHP noted that the continued nationwide shortage of ADHD drugs is “a problem for clinicians and patients. ”
The shortage of popular drugs is even more acute, with Mounjaro, the diabetes drug known as the “slimming pill ”, already in dire straits.
In response, Lilly said that the “unprecedented surge in demand ” for Mounjaro and its similar drug Zepbound has led to a shortage in the market, which the company is struggling to cope with.
Lilly is ramping up investments to boost production at Mounjaro and Zepbound in the second half of 2024.
The company said it expects intermittent supply disruptions in the near term due to unprecedented demand.
How to cure the drug shortage
The last major “drug shortage ” in U.S. history occurred in 2014, and it has only been alleviated in the years since.
Since 2021, the drug shortage situation seems to be increasing, and scholars in the field of medical health and economics in the United States believe that the reason for most drug shortages in the United States is the fragmentation of the drug supply chain.
The White House this month proposed spending between $3.26 billion and $5.11 billion over the next decade to help address the nation ’ s drug shortage.
The bill requires approval and funding from the U.S. Congress.
U.S. researchers and policymakers believe that a complete solution to the “drug shortage ” may require changes to the business model of the U.S. pharmaceutical industry, including measures to increase the price of generic drugs to attract more drug manufacturers.
Policymakers recommend giving the FDA more power to access more information about drug shortages and impending shortages.
Currently, the FDA relies primarily on phone calls to manufacturers asking if they can increase their supply to understand the situation.
The American Society of Health System Pharmacists said it is working with the federal government to advise the government on measures to address the drug shortage, including that Congress should require manufacturers to be more transparent on any supply chain issues and encourage more diversity in supply chains.
According to Abramowitz, “The federal government still has a lot of work to do to fundamentally address drug shortages, and the American Society of Health System Pharmacists will continue to engage regularly with policymakers to guide them in drafting and passing new legislation to address drug shortages and continue to advocate vigorously for proven solutions on behalf of our members. ”

US cancer centers short on carboplatin, cisplatin, methotrexate, 5‑FU, fludarabine, hydrocortisone.

Title:

Content: How the Chemotherapy Shortage Is Affecting Frontline Clinicians

— "How are we here in 2023 having some of these discussions?" bemoans gynecologic cancer expert

MedpageToday
  • Emily Hutto is an Associate Video Producer & Editor for MedPage Today. She is based in Manhattan.

In this exclusive Instagram Live clip, Jeremy Faust, MD, editor-in-chief of MedPage Today, and Eleonora Teplinsky, MD, head of Breast and Gynecologic Medical Oncology for Valley-Mount Sinai Comprehensive Cancer Center in Paramus, New Jersey, discuss how the recent shortage of the chemotherapy mainstays cisplatin and carboplatin have impacted cancer patients and frontline clinicians.

The following is a transcript of their remarks:

Faust: Dr. Teplinsky, let me ask you about your side as a frontline clinician in this area. As an ER doctor, I don't type in, "Let's give a patient cisplatin." That's not an order that I put in. So, how long have you been seeing shortages like this that affect your patients?

Teplinsky: I would say around April -- again, talking about this particular shortage with carboplatin and cisplatin -- I think around April we started hearing about it. But it was one of those things, I'll be honest, where you're like, "Oh, this can't possibly happen. This is happening somewhere else. This isn't affecting us."

Then I think NBC ran an article on it. Then for a month nothing happened, and then all of a sudden, I would say in May, it really kind of exploded in the sense that many, [the] majority of cancer centers were either experiencing complete absence of drugs or shortage of drugs. They weren't able to procure it from their suppliers.

That quickly made its way to the patients not being able to get the drug, or having to sit in front of a patient and say, "I have a treatment for you. I don't know if you'll get it. I don't know when you'll get it. I don't know what dose I can give you."

And imagine, you're already facing this life-changing diagnosis, but there are drugs -- you just don't know when you'll get them. I think that we don't talk enough about that emotional toll that takes on patients, because the uncertainty that everyone was facing was really quite tragic.

Faust: When you had that conversation with a patient -- I guess it depends on the kind of cancer, doesn't it? Because there are certain oncologic conditions where we're so fortunate that we have many, many regimens. Maybe this one is a tiny bit better than that one and you're sort of scraping out on your Kaplan-Meier curves, your survival curves, a couple of months here. Are you able to reassure your patients, or does it really depend on the kind of cancer that we're talking about?

Teplinsky: It really depends on the kind of cancer.

I will say that the Society of Gynecologic Oncology really led the way with this because, unlike in other cancers where you can substitute, in gynecologic cancers it's really hard -- you need the platinum drugs. So they led the way. And then ASCO, the American Society of Clinical Oncology, followed and came up with guidelines for clinicians about when you can substitute, what you could substitute. Can we spread out the dosing, so instead of every 3 weeks, can we give it every 4 weeks to make the drug last longer? Can you reduce the dose?

Conversations that, again -- how are we here in 2023 and having some of these discussions? But that's kind of what happened.

The challenge really was: do we have data to substitute? Will you sacrifice the efficacy if you switch from one drug to another? Then as a result, if now everyone is shifting to this drug, do we have supply for the other drugs? So I think [they really were] very difficult discussions. And again, for some disease types we were able to make that switch, but not for all.

Faust: OK. I want to jump over in just a second to some of the policy side, but let me stick with you for one moment just to pursue that point a little further.

I study outcomes, mostly with COVID, but lots of other things too. But when you're making these switches, I know that in pediatric oncology, for example, they're always tweaking and testing and saying, "Let's compare A to B and see how they do." As this is happening, is this just too chaotic for anyone to stop and say, "Well, actually this is a little bit of an unfortunate opportunity to see well, are these biosimilars actually behaving decently comparably?" Or is it just too random for anything to be learned from this?

Teplinsky: Yeah, I think that it would've been great to be able to study, but it was too erratic because everyone was at different points in their treatment cycles. Some people had gotten five cycles and they had one more left. Other people were just starting out. Some of those patients we had to pivot and not do chemotherapy first, for example, and do surgery first where we normally wouldn't. So the circumstances and the situations were each too different to actually look at this in a cohesive way.

I do think that, fortunately, people moved fairly quickly to try to get drugs and try to increase supply. So we were in this bad point for a couple weeks, but it started to recover, but now we're seeing a different shortage of 5-fluorouracil.

I am curious about this from the policy side, but unless we really come up with long-term solutions, the short-term solutions are going to just lead us to another drug shortage in 3 more months for something else.

Faust: You mentioned the word "allocation" and that set off a thought that I wanted to talk about on the clinical side. So Dr. Teplinsky, we know that drugs don't reach every community equally, right? There are certainly "haves" and "have-nots" and the in-between. From the standpoint of oncology, do we sense that when shortages happen, there's a disparity in terms of who's affected?

Teplinsky: Absolutely. I mean, I think we have to keep in mind that the majority of patients are still treated in the community setting.

For this particular shortage, NCCN, the National Comprehensive Cancer Network, did a study of multiple NCCN sites and they found that about 93% were affected by the shortage in some way. What we don't have information on, again, is in terms of exactly which settings were more affected than others.

Understandably, patients, if they are treated in a community site that maybe is not a big center -- that's a small site that purchases a very small amount and didn't stockpile -- those people are going to be predominantly affected. And very often they cannot travel to a bigger site that has more resources if they're in a setting where this is the only site or they are limited by socioeconomic disparities.

Absolutely, this heightens the already ongoing disparities that we see in cancer treatment. Absolutely.

Faust: In terms of how that plays out for your patient population or your colleagues, does this lead to your job being a lot of case management, in a sense? You know the medicine, you know the drugs, but what you need to figure out is who has what and who can go where. Is that really where a lot of resources and your time get spent in your office?

Teplinsky: I mean, that's part of it.

I think the challenge too is that, a couple months ago, no one knew when more drugs would arrive. So a lot of places were also sharing with each other, but they were also hesitant about taking on new patients, right? Because if we can't even provide for our existing patients, what's that going to look like?

But I think the other piece that really is challenging is, if you do have a limited supply, who do you prioritize it to? This was something we saw in COVID also in terms of access to care when the pandemic was at its height. The same thing now: do you give [the drugs] to the person that is going to be cured, hopefully, with this, or someone who needs it for a palliative reason? But how do you make that distinction?

I think those are really challenging questions and really hard decisions for physicians to have to make.

Faust: What do you tell a friend -- not a patient, because a patient's coming to you and you're going to treat them -- if someone says, "Look, I got a biopsy and they're sending me to this oncology center or that one," would you tell them to look into this? You don't want to go down a pathway with a wonderful practice who actually can't treat you, when across the street for reasons that we just discussed a minute ago -- some negotiation or someone got it ahead of a stampede in a panic -- they have the drug.

Would you advise patients who are looking at this landscape to behave any differently than they would've in another environment?

Teplinsky: Absolutely. I mean, I'm a firm believer that patients have to be their best advocate and you have to be your own advocate. I think it's a very appropriate question to say when you're meeting a practice, "I know that my regimen is recommended to have carboplatin," for example, "Can you talk about where your institution or cancer center or hospital is with regards to these shortages?" I think that those are very valid questions.

Part of the things that we say: what should you ask your oncologist? I think in this space and time that we're in, that should be part of the list. Because again, like you said, you don't want to all be set up for treatment to find out that they don't actually have the drug.

I think the challenge is in patients who are not able to do that, who are not able to go somewhere else, and that's really hard.

Faust: Yeah. It's interesting to me, again, I'm an ER doctor, but I work in a pretty fancy magnet hospital. People always come to us for second opinions or for the magic stuff that Dana-Farber [Cancer Institute] might have, as if it's any different.

In some cases, look, we have wonderful experts and we have some experimental treatments that are unavailable everywhere else. But a lot of times when it's straightforward, I kind of feel like we've got a nation of really, really qualified oncologists. You don't need to fly halfway across the country to get first-line treatment. And yet, some people actually would do that. They want that name brand.

But now you could argue that the big-name brands are probably the ones that have the most purchasing power and bargaining power, so all of a sudden it might matter, right?

Teplinsky: Yeah, I think we don't know. And it varies. I mean, some of the biggest cancer centers were actually the ones experiencing some of the bigger shortages.

Faust: Oh, really?

Teplinsky: It was very variable throughout the country, but you could see on Twitter, people were sharing, "Who's got the drug? Who doesn't have the drug?" So it really was very surprising, actually, that this hospital had it, this cancer center didn't, and vice versa.

It's also such a fluctuating state, right? You might have it tomorrow, you might not have it the next week, which is why I think this was so hard for patients because there was no guarantee of when it would come back. I think that really exacerbated all of it as well.

Title:

Content: Advertisement

U.S. cancer centers report ongoing shortage of chemotherapy drugs

By Cara Murez, HealthDay News
In all, 72% of cancer centers surveyed reported a continued shortage of carboplatin. And 59% were still seeing a shortage of cisplatin. Photo by klbz/Pixabay

U.S. cancer centers continue to have shortages of commonly used chemotherapy drugs, a new survey shows, though the medications are not as scarce as they were last June.

The National Comprehensive Cancer Network (NCCN), a nonprofit alliance of leading cancer centers, surveyed its network in September.

In all, 72% of cancer centers surveyed reported a continued shortage of carboplatin. And 59% were still seeing a shortage of cisplatin.

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These two platinum-based generic chemotherapy medications are recommended for treating many different cancers. Overall, 86% of centers surveyed said they were short on at least one type of anti-cancer drug. A survey in June showed that 93% of cancer centers had a shortage of carboplatin, and 70% of cisplatin.

"Everyone with cancer should have access to the best possible treatment according to the latest evidence and expert consensus guidelines," said Dr. Robert Carlson, chief executive officer for NCCN.

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"Drug shortages aren't new, but the widespread impact makes this one particularly alarming. It is extremely concerning that this situation continues despite significant attention and effort over the past few months. We need enduring solutions in order to safeguard people with cancer and address any disparities in care," Carlson said in a NCCN news release. Twenty-nine of the NCCN's member institutions responded to the September survey. They include leading academic centers across the United States. The findings may not reflect additional challenges that smaller community practices serving rural and marginalized patients are experiencing. The centers surveyed were using strict waste management strategies, so nearly all were still able to provide the medications to all patients who needed them. Other medications in short supply included methotrexate, with 66% of centers reporting a shortage; 5-fluorouracil, with 55% falling short; fludarabine at 45%; and hydrocortisone at 41%.

"These drug shortages are the result of decades of systemic challenges," said Alyssa Schatz, NCCN's senior director of policy and advocacy. "We recognize that comprehensive solutions take time."

Schatz said the network appreciates those who have put forth proposals to improve investment in generics.

"At the same time, we have to acknowledge that the cancer drug shortage has been ongoing for months, which is unacceptable for anyone impacted by cancer today," Schatz said. "These new survey results remind us that we are still in an ongoing crisis and must respond with appropriate urgency."

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The organization is continuing to advocate for more supplies.

CNN recently reported that two other drugs used for cancer, vinblastine and dacarbazine, went into shortage in September.

"These drugs are particularly used to treat patients with Hodgkin's lymphoma. Hodgkin's lymphoma is probably one of the most curable types of cancers out there," Dr. Doug Hawkins of the Children's Oncology Group, a research organization, told CNN.

"The problem is never-ending. It is horrible," he added. "I mean, to say to a patient, 'we know how to treat your child, but we can't get the drugs,' and this is America, and it's 2023 -- it's crazy."

More information

The White House has more on strengthening the supply chain for cancer drugs.

Copyright © 2023 HealthDay. All rights reserved.

Latest Headlines

US pharmacies 66% lack amoxicillin, 89% lack Adderall.

Title:

Content:
The Shortages Are Coming

by Tyler Durden
Tuesday, Nov 08, 2022 - 09:20 PM

Authored by Michael Snyder via The End of The American Dream blog,

Do you remember in early 2020 when they told us that the shortages that we were experiencing would just be temporary?  Of course some of them were, but then more shortages just kept on erupting.  That wasn’t supposed to happen, and now it appears that our supply chain problems could potentially get a whole lot worse.  In just a few short months, we will be three years away from the beginning of the pandemic in the United States.  But instead of a “return to normal”, more shortages are on the way.  And in some cases, they could even be life threatening.

Let me give you an example.  We need Amoxicillin to treat some of the most common infections that our children experience.  Unfortunately, the FDA is warning us that we are now facing a very serious shortage of Amoxicillin…

Ear infections and strep throat.

Both are common childhood illnesses, for which the go-to prescription is in short supply, according to a recent nationwide alert from the U.S. Food and Drug Administration.

The warning specifically involves the powder, which pharmacists use to mix liquid Amoxicillin for childhood infections.

This is a really big deal.

According to one recent survey, close to two-thirds of all pharmacies in the nation are having difficulty getting Amoxicillin right now, and the national shortage of Adderall is even worse…

Nearly 66% of pharmacies are having challenges obtaining amoxicillin, according to a new National Community Pharmacists Association (NCPA) survey of 8000 pharmacy owners and managers, whereas 89% are realizing a shortage of Adderall.

Of course we are dealing with lots of other drug shortages at this moment as well.

In fact, according to the official FDA drug shortage list there are nationwide shortages of a whopping 183 different drugs in the United States right now.

We truly are in unprecedented territory.

Up in Canada, things are even worse.

If you can believe it, at this point the Canadians are facing “an acute shortage of basic painkillers”

The Canadian healthcare system is experiencing an acute shortage of basic painkillers, particularly acetaminophen and ibuprofen, which are commonly used to relieve pain and fever in children during flu season.

Canada’s Association of Medical Assistance in Dying Assessors and Providers (CAMAP) chose this perhaps awkward moment to roll out a webinar for healthcare professionals that advised them to offer assisted suicide to their suffering patients.

So why don’t the Canadians have enough Acetaminophen and Ibuprofen right now?

Well, we are being told that the primary reason is “a lack of raw ingredients to make the drugs”

CBC News quoted health officials who blamed “a lack of raw ingredients to make the drugs,” “an uptick in respiratory viruses fueled by the relaxed [Chinese coronavirus] measures,” and “panic buying” for the shortage of painkillers for children.

As I have covered in previous articles, most of the basic ingredients that go into our pharmaceutical drugs come from China.

So if you think that things are bad now, just wait until war with China erupts.

Once that happens, our pharmacies will get really empty and our entire healthcare system will experience a historic meltdown.

Switching gears, with Thanksgiving coming up I wanted to talk about the fact that we are now facing a nationwide shortage of turkeys

As CNBC reports, the price of turkey is up 73% from last year, a pretty astonishing figure. Experts attribute it to the bird flu, which has devastated turkey stocks this year. Apparently, the disease normally doesn’t flourish during the summer as farmers get their holiday flocks together. But, you know, the 2020s haven’t been easy so naturally, the flu hit hard right in the middle of the year when it could do the most damage.

The good news, if you want to call it that, is that you will still probably be able to get a turkey if you are willing to pay enough.

The bad news is that supplies of turkey just keep getting tighter and tighter.

One business owner in San Francisco recently stated that it is “like pulling teeth trying to get turkeys from the companies” at this stage…

But it’s not just the Thanksgiving bird that’s at risk — it’s your lunchtime turkey sandwich, too. San Francisco delis and butchers are already feeling the effects of the shortage.

“It’s like pulling teeth trying to get turkeys from the companies,” said Sal Qaqundah, owner of Arguello Market, a San Francisco cult favorite for its “world famous” turkey sandwich.

Unfortunately, we are also facing a shortage of butter in the weeks ahead.

The USDA is urging consumers not to “panic buy” butter so that there will be enough to go around for everyone…

Butter is another area where the war and cost of dairy products has affected supply, as the price of the condiment and baking ingredient has gone up a dollar per pound since January of this year, per Eater. Fearing a full-blown butter shortage, the USDA has asked consumers not to rush or panic buy, but simply secure what they need at a given time, per Best Life.

Did you ever imagine that we would be talking about a butter shortage in late 2022?

Things just keep getting crazier and crazier.

And if the diesel fuel shortages eventually get as bad as some are projecting, we could soon be facing severe shortages of countless products.

Our ships, our trains and our trucks run on diesel fuel.

So if there is not enough diesel fuel, we are going to have a real problem trying to fill up our stores with enough stuff for everybody.

Even now, supplies of diesel fuel are so tight that one big player in the industry just issued a major alert

A major fuel supply and logistics company is raising a red flag on upcoming diesel fuel shortages.

Mansfield Energy issued the alert Friday stating there was a developing diesel fuel shortage in the southeastern region of the United States. The company speculated that the shortage could be generated from “poor pipeline shipping economies” and a historically low supply of diesel reserves.

“Poor pipeline shipping economics and historically low diesel inventories are combining to cause shortages in various markets throughout the Southeast,” the company said. “These have been occurring sporadically, with areas like Tennessee seeing particularly acute challenges.”

There are a number of reasons why supplies of diesel fuel have gotten so tight.

But the biggest is the fact that imports from Russia have been totally cut off

But the primary reason is the cutoff of Russian imports. Prior to Russia’s invasion of Ukraine, the U.S. was importing nearly 700,000 barrels per day (BPD) of petroleum and petroleum products. Most of those imports were finished products and refinery inputs that boosted distillate supplies in the U.S.

The loss of those Russian imports have caused problems for refineries as they struggle to fill holes in their product slates. Refineries do have a small amount of flexibility in shifting gasoline production to diesel production. But it’s a relatively small amount (e.g., ~5% in a refinery I once worked in). That also means that if refiners do shift production, that also potentially creates shortages in the gasoline market.

So why don’t we just produce more ourselves?

Well, thanks to our politicians, the number of refineries in the United States has actually been declining in recent years even as our population has grown.

At this point we simply do not have enough refineries, and this is a problem that is not going away any time soon.

In the months ahead, we aren’t going to completely run out of diesel fuel as some people out there are suggesting.

But supplies may get so tight that it could potentially create widespread supply chain nightmares that are quite severe.

Let us hope that such a scenario does not materialize.

Because the American people are already angry enough about the economy.  In fact, a brand new survey has found that it is the number one issue for U.S. voters at this moment…

The Washington Post and ABC gave Americans eight top issues they will be considering when making their decision in a poll that showed likely voters split between the Democrats and Republicans.

The economy was cited by 26 percent of likely voters as one of the most important factors, followed by abortion with 22 percent and inflation and threats to democracy each by 21 percent.

For decades, we have been able to rely on our supply chains to continuously fill our stores with mountains of cheap goods.

But now our supply chains are breaking down.

In fact, our entire economic system is breaking down and most people are completely and utterly unprepared for the difficult times that are coming.

I know that many of you have been patiently waiting for a long time for life to “return to normal”.

Sadly, that isn’t going to happen.  The incredibly bad decisions that our leaders have been making are now catching up with us in a major way, and a great deal of pain is ahead.

*  *  *

It is finally here! Michael’s new book entitled “End Times” is now available in paperback and for the Kindle on Amazon.

0

Canada faces acetaminophen, ibuprofen shortages due to raw ingredients.

Egypt insulin shortages caused by raw material import issues.

Title:

Content: Chairman of Wafd Party
Dr. Abdul Sindh Yamama
Chairman of the Board of Directors
Dr. Ayman is an accountant.
Editor-in-Chief
I'm sorry.
My grandfather, Zainuddin.
Chairman of Wafd Party
Dr. Abdul Sindh Yamama
Chairman of the Board of Directors
Dr. Ayman is an accountant.
Editor-in-Chief
I'm sorry.
My grandfather, Zainuddin.
Smuggling burns drug stability
Libya and Sudan are the main destinations.
And the profits are huge.
Deficiencies include stents, heart medications, diabetes, pressure, and tumors.
It is an undeniable fact that the Egyptian pharmaceutical market is experiencing a crisis of shortage of some vital items on which citizens depend mainly, and at all levels, which exacerbated the suffering of patients in public hospitals affiliated to the government, which receive subsidized medicines at low prices, so that the so-called alternative class becomes a citizen ’ s refuge, to get the necessary dose of medicine, to alleviate his health suffering or save his life.
At a time when it is assumed that more than 90% of medicines are manufactured in Egypt, citizens' complaints about the lack of many medicines and medical supplies in the markets and hospitals are escalating to the extent that deputies submitted a number of requests for briefing through the deputies, stressing that the crisis lies in the raw material itself and imported in dollars.
And the pressure.
Thyroid and sugar.
The main reasons lie in the importation of 95% of raw materials in addition to the presence of “smuggling brokers ” whose mission is to smuggle Egyptian medicine to neighboring conflict countries, especially Libya and Sudan, in order to sell it abroad at exorbitant prices, and to reap huge profits, according to some pharmacists and specialists. In addition to Sudan ’ s import of Egyptian medicine in hard currency, especially with the licenses of Egyptian medicine compared to others and the stopping of factories in neighboring countries because of their conflicts.
According to Ali Abdullah, head of the Egyptian Society for Pharmaceutical Studies (an NGO), the lack of medicines and their disappearance from the local market is a real crisis in case of smuggling, such as insulin, tumors, anesthesia, surgical supplies, serums and vaccines.
The shortage of hard currency in Egypt is also one of the reasons for the disappearance of medicines.
Mahfouz Ramzi, head of the Pharmaceutical Manufacturing Committee at the Cairo Pharmacists Syndicate, pointed out that there are organized gangs that smuggle medicine to countries of conflicts and wars, explaining that “most operations are conducted through land border roads, and the Egyptian Drug Authority is responsible for inspecting companies, factories and any pharmaceutical institution, to ensure that medicines produced in Egypt are in the normal sequence until they reach pharmacies. ”“ Some smuggling professionals deal with drug stores, where they buy large quantities of medicines, take advantage of discounts on them, and then smuggle them abroad to take advantage of the price difference. ”
The Executive Director of the Egyptian Center for the Right to Medicine, Mahmoud Fouad, confirmed that "the drug stores have turned into an illegal business and a back gate for drug smuggling and expired drug trade, as most of them are not licensed and sold without invoices, and are not subject to the umbrella of the Ministry of Health, in addition to the lack of health standards required to practice the profession of pharmacy, after some stores are run from apartments away from the eyes of the Ministry of the control bodies. 90% of its owners are not pharmacists. ”
“Are these stores registered with the Ministry of Health?
And are they subject to pharmaceutical inspection or from the Drug Control and Research Authority? ”, stressing that most of the small pharmacies in the villages “do not have the ability to buy medicine from distribution companies, which makes them resort to buying from stores after agreeing on specific facilities and periods for payment, ” pointing out that“ popular medicines in Egypt are the most smuggled abroad. ” From 250 pounds ($8 at the official exchange rate).
According to Dr. Ashraf Hatem, Chairman of the Health Committee in Parliament, it is a social responsibility, and priorities must be set, and all parties sitting together may help to solve the crisis, in light of the apparent shortage of a number of medical drugs, and his demand that the Drug Authority publish periodically and daily alternatives to the missing medicines in the absence of the original medicine. In addition, the pharmaceutical industry continues to operate and produce.
For all this and for the continuation of the crisis of drug shortage it was necessary to search and investigate the causes and solutions!
During the meeting of Gamal al-Laith, Chairman of the Chamber of Pharmaceutical Industry at the Federation of Industries, in the presence of Minister of Health Dr. Khaled Abdel Ghaffar, the Governor of the Central Bank, Hassan Abdullah, and others, he sent letters of reassurance to the Egyptian people about the existence of a solution to pump the needs of the market of foreign currency to end the shortage of medicines. Or psychologically for the patient.
He said: « The medicines that suffer from the shortage, some of them are sugar drugs and other drugs tumors and drugs of the glands and heart, drugs related to chronic diseases, which is now being secured, and we as factories work with a stock of raw materials enough for 4-6 months, and this stock reached only weeks, and therefore we are now in the stage of risk, and therefore the government began to move ».
He added that the health sector is supported by the provision of foreign exchange resources to provide all needs according to a plan to deal with such circumstances, stressing the importance of full coordination between the unified purchasing authority and the pharmaceutical industry room as well as pharmaceutical companies to face any problems related to the shortage of supplies, medicines and medical consumables.
As well as a detailed presentation on the commitments implemented and not implemented in the period from June 2023 to January 2024, with regard to the provision of (medicines, medical supplies, laboratory supplies, devices, raw materials and packing materials), and the Minister was briefed on the results of the mechanisms established with the Central Bank of Egypt to pay the obligations in foreign currency to meet the demands of the health care sector.
In the end, the official spokesman stressed that the shortage of drugs does not exceed 15% and the drugs directed to tumors are at the forefront of the shortcomings because of their close link to the currency and what faces the supply chains, otherwise all drugs and within them are compatible... The complaints are due in their entirety to the lack of knowledge of citizens with the trade names of medicines.
In addition to the above, a severe shortage of anesthetic drugs, dental pening drugs, nephrology and recovery drugs, which will cause a real disaster that threatens the conduct of surgical operations for patients, and thus increase the waiting lists in hospitals and the occurrence of complications for patients that may result in loss of their lives.
The head of the medicine division of the Federation of Chambers of Commerce, Ali Ouf, revealed that a request will be submitted to the Egyptian Drug Authority early next week to move the prices of 1,500 items in light of what he described as developments in the situation and rising costs.
He pointed out that « the need to raise the wages of workers in the pharmaceutical sector to compensate them for the cost of living and therefore must raise salaries so that they can live in the current conditions and the sector will bear the increase of salaries at the expense of cost and raise the minimum insurance ».
On the shortage of medicines, Amin al-Dabraki, one of the dealers in the pharmaceutical market, said that the main reason for the crisis is the lack of active substances imported by companies.
This is mainly due to the dollar crisis, in addition to the withdrawal of some financial companies from the Egyptian pharmaceutical market.
On the inability of the Ministry of Health to move the prices of medicines with the movement of the exchange rate, he said that the solutions are the intervention of the state by providing a fixed customs dollar for pharmaceutical companies, while moving the prices of medicines, in addition to starting factories to produce active substances inside Egypt.

Title:

Content: Saturday 13 July 2024
Chairman of the Board of Directors and Editors
Abdurrahim Ali
Editor-in-Chief
Dalia Abdul Rahim
Chairman of the Board of Directors and Editorial Board
Abdurrahim Ali
Editor-in-Chief
Dalia Abdul Rahim
Reports & Investigations
A “cure ” for the lack of medicine.
News portal monitors the suffering of health insurance patients..
Health Minister Apologizes to Citizens
Head of the division: Insistence on using the trade name exacerbates the problem
Follow the latest news through the app
Hundreds of chronic disease patients from health insurance clinics suffer from a lack of treatments and medicines, especially diabetics; because of the lack of insulin and many other medicines that are not available, where the journey of great suffering begins after the patient leaves the examination room and the doctor writes the necessary treatment in the prescription, to surprise patients that the treatment does not exist and he has to look for it himself.
In this report, "Al-Bawaba News" monitors the suffering of patients looking for medicine in light of the lack of the market of local and imported medicines in health insurance pharmacies and free market pharmacies, where « Al-Bawaba » met "Amina", a 50-year-old woman suffering from diabetes, went to health insurance in the city of Al-Mahalla Al-Kubra, in an attempt to get her treatment to clash with reality. The health insurance deducts a fixed monthly subscription for her treatment, but the head of the pharmacy inside Ibn Sina Clinic in Mahalla Al-Kubra confirmed that the treatment is not currently available, and that the patient must go to three pharmacies affiliated with the Health Insurance Authority, and three pharmacies outside it affiliated with the Health Insurance also, to get the medicine.
"Amina" did not despair of attempts and despite her illness, she went to 6 pharmacies affiliated with health insurance inside and outside the headquarters and did not find sugar medicines available, even she did not find it in the free market in various pharmacies.
The suffering continues.
Amina ’ s condition is not unique in the midst of a hustle of medication shortages, as Menna Magdy from Giza also complained about the lack of insulin and tapes needed for a glucose meter, which has become rare.
“Mina ”, the mother of a diabetic child, said:“ I am a son diagnosed from 1 year and 4 months with diabetes type I take Novo Rapid and sediment, of course we are supposed to take insulin from insurance and imposed according to measurements, but they do not need enough insulin in the middle of the lack of drugs, and when Benji I spend the treatment every two months..
We have to take medicine from other patients. ”
She pointed out that there is a clear suffering that appears in the patient groups and we are trying together to find solutions to the shortage of drugs, insulin and tapes, even in pharmacies in free markets we do not find.
She added in desperation: "We kept reducing the quantities of medicine against our will and from how many days of insulin ended up on the pharmacies of October all so that I find one Novo pen but not you."
In the governorate of Ismailia, despite the application of comprehensive health insurance in the governorate, but she has seen a shortage of medicines inside pharmacies, "Rawda", a mother of two diabetics, says that she suffers from the provision of medicines to her children with immune diabetes, where for the past 3 months she was unable to provide medicine from health insurance.
She added that after suffering a few doses were dispensed and without sugar measurement strips, and added that some substitutes of drugs for diabetes led to double pathological symptoms, where one of her children suffered from a high cumulative rate of up to 15 and enter the intensive care.
She pointed out that the shortage of medicines is not only in health insurance pharmacies and the public sector, but in free pharmacies, where she is looking for medicines in her province and neighboring provinces in order to obtain the prescribed doses of sugar for her sons.
Lack of medicines
Dr. Mahmoud Fouad, Executive Director of the Right to Medicine Association, stressed that there is a shortage of many medicines for many diseases such as immunological diseases, Mediterranean anemia, SLE, Duchenne diseases, muscular dystrophy, neurologic and psychological drugs, in addition to some hormone drugs.
Fouad explained in a statement to "Al-Bawaba News", that diabetics suffer from the lack of availability of some diabetes drugs, especially popular insulin, although there is an increase in the recent drug varieties to more than 30% of the drugs.
Fouad pointed out that there are some traders who store medicines in stores to offer them in the market at new prices, in addition to many problems related to imported medicines, which have also increased their price significantly.
Fouad pointed out that there is a new increase in a large number of items in the coming days by up to 50% and up to 80% for imported medicines.
In the same context, Dr. Ali Auf, head of the medicine division of the Federation of Chambers of Commerce, said that the problem of medicine shortage is not only related to the provision of medicine from the state or pharmaceutical factories, but also related to the culture of the citizen in dealing with these medicines.
The head of the medicine division said in statements to "Al-Bawaba News" that the citizen deals badly with drugs in two cases, the first of which is to store a large amount in the case of a shortage and then provide it in pharmacies; for fear of suffering in obtaining it if shortage, and thus causes this behavior to deprive other patients to get their doses on time.
He added that the other wrong behavior is the use of essential drugs to treat some diseases such as diabetes in the treatment of another disease such as obesity, and therefore drugs are consumed at a higher rate than the production of companies, which makes the period of the end of the crisis longer than necessary.
He pointed out that most sugar medicines (pills) are available under the scientific name and not the commercial name, and that local insulin is manufactured internally and 85% of the insulin available in Egypt is local production, but the production covers the needs of health insurance and hospitals of the Ministry of Health and the government sector.
He added that there is a crisis in imported insulin, where it is available only by 15%, and international factories adhere to a production plan, and therefore in the case of increased consumption of drugs is not increased production in the actual time for the shortage of medicine, and thus patients in the local market resort to Egyptian insulin shows demand for medicine, which is a pressure and shows cases of drug shortage.
He pointed out that there is a near breakthrough to provide medicine, and that it is easy for Egyptians to deal with the scientific name and not commercial, and in case of any drug shortage, call the ambulance pharmacies available in Greater Cairo and the governorates through the hotline 16682 or call the Drug Authority on the hot number 15301; to find out where any medicines are missing and the scientific alternative to it.
For its part, the Drug Authority explained through its official page on Facebook that there are many alternatives to authentic medicines and all of them are safe and have the same effect and effectiveness as the original medicine; pointing out that the alternative medicine, is a medicine composed of an active substance different from the original medicine, but it is used to treat the same disease.
The Egyptian Medicines Authority advised that you should consult your doctor or pharmacist before using an alternative medicine as they can help you ensure that the alternative medicine is suitable for you and that it will not interact with any other medicines you are taking.
In the same context, the Authority said in a press release that Dr. Ali Al-Ghamrawi, President of the Egyptian Drug Authority, received a delegation of representatives of local companies and the Chamber of Pharmaceutical Industry to discuss ways of cooperation between the Authority, companies and the Chamber to provide medicines and necessary supplies in the Egyptian market.
Promises of the new government
In his first remarks to the new government on the crises of medicine, Prime Minister Mostafa Madbouly said today in a press conference that the pharmaceutical sector in Egypt follows the private sector, and that the state is coordinating with the private sector to reduce the prices of medicine, stressing that the state is keen to stabilize the prices of medicine, especially that the Egyptian medicine is cheaper than most countries in the world.
He explained that the state is procuring the dollar to provide raw materials for manufacturing, and that the import of raw material at the daily price of the dollar caused great losses to the state.
Timeline
On the lack of medicine, the Prime Minister said that the drug prices were coordinated by the Drug Authority after developing a plan with the companies for the absence of any shortage of medicines in the coming period, and explained that the drug productivity takes a great time in manufacturing and therefore there is a shortage of medicines in the markets, pointing out that the coming period will witness a great abundance of medicines.
For his part, Dr. Khaled Abdel Ghaffar, Deputy Prime Minister and Minister of Health, revealed that the drug file is important and has a dimension in the Egyptian national security, and affected like any commodity with dollar components during the last year and a half in light of the existence of global crises.
He explained that since the beginning of the crisis and the perception of the lack of currency to cover the needs, priorities have been set so that the citizen does not feel a shortage, stressing that the guests from Gaza and Sudan are all additions that affected the requirements of production and the basics of the pharmaceutical industry of raw materials.
He added that there were deficiencies in some types of medicines, but there are alternative or similar medicines and this culture is not approved by many, in the absence of the medicine written by the doctor they say it is incomplete.
Dr. Khaled Abdel Ghaffar, Deputy Prime Minister and Minister of Health, continued that Egypt is the cheapest country in the world in medicine, and the unable is not affected by the high prices of medicine, adding that the state provides it and the Egyptian pharmaceutical industry covers 95% of the needs.
He added that there are 69 million citizens who are insured in the health insurance system that has existed since the 1960s, in addition to the beneficiaries of treatment decisions at the expense of the state.
Dr. Khaled Abdel Ghaffar, Deputy Prime Minister and Minister of Health, said that the drug pricing procedures are the prerogatives of the Egyptian Drug Authority, pointing out that the increase in drug prices will be in the range of 30 to 35%.
The minister apologized.
The Minister of Health apologized to the citizens for the shortage of some medicines in the markets during the recent period, stressing that during the next few months there will be no shortage of imported or local medicines, as the import of raw materials began to restart production and will be in cooperation with the entire minister to take care of the pharmaceutical industry.
He added that the state is keen to provide all the necessary capabilities for the treatment of patients and the provision of medicines, and that there is an upcoming international cooperation with the international institution "Gustav" for the treatment of tumors in France, which does not have a presence outside France.
It receives patients from all over the world, which is the center of excellence for the treatment of tumors in the world, and the efforts of the Egyptian government have been successful in persuading it to receive the center with all its competencies and expertise to participate the Ministry of Health in the work of a hospital in Egypt.
He explained that Egyptian doctors will be trained abroad to transfer international experiences and expertise to Egypt, stressing that the citizen will be treated at the highest international level without incurring any dime, but paid instead by the state through health insurance.
He stressed the completion of 24 projects to develop hospitals at a cost of 7.34 billion pounds, adding that there are 20 new projects in 11 governorates and these hospitals will operate with a capacity of 2,747 beds.
Dr. Khaled Abdel Ghaffar, Deputy Prime Minister and Minister of Health, said that the presidential initiatives launched by President Sisi led to an increase in the average age of the Egyptian human being.
Dr. Abdul Ghaffar explained that the national projects plan from 2025 to 2026, stressing that it includes 54 projects in 24 governorates in the Republic and will operate with a capacity of 9588 beds.
Dr. Abdel Ghaffar added that the comprehensive health insurance project will end in 2030 and will cover all governorates of the Republic, stressing that Egypt has received thousands of sick and injured cases coming from the Gaza Strip, and will be assisted in rebuilding the health system in the Gaza Strip within the framework of Egyptian assistance to the brothers.

Egypt shortages of heart, bone, cancer, joint, epilepsy, hypertension, thyroid, diabetes drugs.

Saudi Arabia reported 1,372 missing drugs, raw material shortages.

Title:

Content: Chairman of the Board of Directors and Editors
Mohamad Elbaz
Chairman of the Board of Directors and Editors
Mohamad Elbaz
Egypt is the cheapest and the crisis will be resolved in two months.
Details of the press conference of the President of the Drug
Dr. Ali Al-Ghamrawi, head of the Drug Authority, said that the phenomenon of drug shortages exists globally and is not limited to Egypt, pointing out that a country like Saudi Arabia has 1372 drugs that are deficient according to an official statistics there.
This came during the press conference held by the President of the Drug Authority, today, to announce all developments related to the drug file, at the headquarters of the Egyptian Drug Authority in Mansouria.
He added that Ecovia gives statistics on the drug market month by month in Egypt with an accuracy of 92%, which confirmed that the shortage rate in Egypt is 7% in 2023 compared to 2022.
Al-Ghamrawi said that the reasons for the shortcomings are due to several reasons, most notably the shortage of raw materials, the rise of spare parts for production machines, in addition to the increase in the dollar exchange rate, stressing that inflation rates and the increase in the interest rate directly affect the price of medicine, pointing out that all these factors directly affect the price of the product.
He explained that the increase in the dollar price led to the tendency of companies to consume their strategic stocks for the production of pharmaceutical items, and after the easing of the dollar crisis and with the increase in the exchange rate, by extension, increased the price of imported raw materials and therefore increased the prices of pharmaceuticals.
He stressed that there will be a breakthrough in the crisis of drug shortages in two or two and a half months at the latest, after the availability of raw materials in the supply chains of companies.
Al-Ghamrawi explained that Egypt is the cheapest price of medicine in the world, pointing out that the raw materials that are imported from abroad at a time when the exchange rate of the dollar was less than the current time, which caused a difference in the price at the present time.
The President of the Drug Authority said that the Authority is negotiating with the drug companies to reduce the prices of some of their medicines and there is a response from a number of companies, adding that today a decision was signed to reduce the prices of medicines for two companies.
He stressed that there are drugs that will see a decrease during the coming period, and not only an increase, and the Authority aims to achieve the general interest of the patient.
He pointed out that there is a rule to increase the prices of medicine, so applications are not considered if the foreign exchange rate increases or decreases by 5% or 7%.
Reasons for requests to raise the price of medicine
Al-Ghamrawi stressed that the Authority is discussing with the pharmaceutical companies the reasons for their requests to raise the price of the drug, and the requests go through nine steps, until the final pricing is reached and the drug is not priced in a moment, but all aspects of the reasons for the price increase are discussed.
He explained that the importance of the Authority is the availability of medicines that are missing in the market, explaining that the Authority has a priority in the provision of medicines, which are medicines for chronic diseases.
Al-Ghamrawi explained that there is continuous control by the inspectors of the Authority on the factories during production, which determines the pricing of the drug through several important factors determined by the Authority with the companies.
He revealed the total campaigns launched during the period from January to protect the control of the pharmaceutical market, pointing out that 46 thousand inspection campaigns were launched on pharmacies and stores resulted in 5,700 violations, and 264 administrative closures, stressing that the Authority has a very strong inspection apparatus.
He stressed that Egypt has great potential in the manufacture of medicine, pointing out that Egypt is number one in the manufacture of medicine in the African continent.
He explained that Egypt has a large number of factories that produce medicine, making it one of the most important countries that make the impossible in Egypt.
He pointed out that there are agreements between the Egyptian Drug Authority and some African countries to provide medicines in Egypt, pointing out that there are five countries have agreements between them and the Authority and there is an expansion in the African market during the coming period.
The head of the Egyptian Pharmaceutical Authority confirmed that the private sector contributes 95% of the production in Egypt and 5% of the production is owned by the government sector.
Al-Ghamrawi explained that this percentage does not cause any crisis because there is continuous cooperation between the local private sector and the Authority in the provision and distribution of medicines, pointing out that 91% of every 100 medicine packs in the market are manufactured in Egypt by factories owned by local pharmaceutical companies (74%) and 26% by international companies.
He pointed out that there are 12 examples of drugs, pointing out that if there is no specific class there are examples and alternatives available, which must be addressed by the citizen, which is the search for analogues and not for the trade name.

Title:

Content: Thursday 18-07-2024
Medication crisis in regional markets.
The Jordan Golden Box
The history of the pharmaceutical industry dates back to the Middle Ages, where the first Islamic pharmaceutical store was established in Baghdad in 754, while the Arab pharmaceutical industry dates back to 1938, where the first Arab pharmaceutical industry was established in Egypt, followed by Syria in 1956, Jordan in 1960, Saudi Arabia and the Arab Gulf countries in 1980.
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In the 19th century, pharmaceutical industries developed in Europe and America, and in the 1950s, the development of industries began to develop a more sophisticated scientific and systematic approach until the introduction of innovative pharmaceutical, biological and biological analogs, including vaccines, in addition to the recent introduction of artificial intelligence in manufacturing, production and marketing and all components of the health system.
Most Arab pharmaceutical industries have not been able to enter this field due to the high cost and lack of infrastructure sometimes and their dependence on the production of sexual and similar products in addition to flooding the markets with similar products by local companies. In the future, most pharmaceutical industries will continue to enter this field as it is the most important element of progress and the gate of scientific and technical investment.
It is worth mentioning that the size of the global pharmaceutical market is about 1.5 trillion dollars, while the size of the Arab pharmaceutical market is about 38 billion dollars, the Gulf is about 18 billion dollars, the Saudi market is the largest with about 9.2 billion dollars and the UAE 4.5 billion dollars, while the size of the Turkish market is 33 billion dollars, the African 100 billion dollars and the Egyptian about 8 billion dollars. Pharmaceuticals from various European and American companies, which account for more than 65% of the global market share, and a quick look at the volume of investment in the pharmaceutical sector in Turkey, where the volume of investment in the pharmaceutical sector is 6 billion dollars through 760 pharmaceutical factories and 11 factories of raw materials.
In Egypt, where the volume of investment in the pharmaceutical sector is 3 billion dollars, there are 191 factories, 799 production lines, hundreds of manufacturers, 81 thousand pharmacies and 1200 pharmaceutical warehouses. In Saudi Arabia, where she leads a major campaign to encourage and localize investments in the pharmaceutical and biotechnology industries and focuses on research and development. The UAE is also working to promote investment in the pharmaceutical sector inside and outside the country, where the volume of the pharmaceutical market is close to $4 billion.
In the past years, the pharmaceutical authorities in more than 27 European countries reported a shortage and loss of medicines and the crisis has extended since 2022 and worsened in the other two years to reach the neighboring markets in Egypt, Turkey and Lebanon, where more than 500 drugs have been lost in Tunisia, 1000 drugs in the Egyptian market and 2000 drugs in the Turkish market. Supply and demand are dead, or regional instability and refugee flows.
Drug security is an essential component of a country ’ s national security system.
Although some countries have moved to take protective measures to ensure the drug reaches those who deserve it, the series of drug outages has remained a nightmare for their governments and could last for five years.
Locally, the Jordanian pharmaceutical market is about 1.3 billion, and the volume of employment in the pharmaceutical sector is about 35,000, and the volume of foreign investment is modest, not exceeding $100 million.
In Jordan, the most prestigious country in the pharmaceutical industry, which began since 1960 without interruption, and the Jordanian medicine gained consumer confidence and was able to enter more than eighty Arab and international pharmaceutical markets, where there are 23 factories, 61 production lines, 4000 pharmacies and 500 pharmaceutical warehouses.
In spite of the regional circumstances, the Jordanian pharmaceutical market remained stable as a result of the golden box, which is represented by the prudent government procedures in dealing with the refugee file and the Corona pandemic, the stability of the legislative environment, the modernization of the investment environment legislation and the continuous official support for local industries. Keeping pace with global developments and meet attracting more investments and the needs of the local and regional market to ensure the entry of new investments and work to localize them and not to waste available opportunities and expand the umbrella of reference pricing and review profits in the pharmaceutical sector to facilitate the entry of investments to the local market and simplify procedures and encourage the rational use of medicines. The destruction of infrastructure, the collapse of the health system and the displacement of the people of Gaza, and this requires taking the initiative to complete Jordan's leading and preventive role, especially as Jordan has stability in legislation and transparency in the pharmaceutical sector and move towards localizing more investments in the field of innovative medicines and biotechnologies and building local and international partnerships instead of imitating similar industries.
There is nothing to prevent the entry of sovereign investment funds to the state from entering this field, as these funds do in Saudi Arabia and the UAE.
It has become a necessary and important step in the golden box to accelerate the establishment of a platform to lead the transformation in the pharmaceutical and biotechnology industries, build strategic partnerships, introduce artificial intelligence system in the pharmaceutical and pharmaceutical sector, and attract investments to enhance national and regional Arab pharmaceutical security before it is too late.

Tunisia lost 500, Egypt 1,000, Turkey 2,000 drug items.

US FDA requires manufacturers to report production disruptions 6 months early.

Title:

Content: FDA gave instructions to pharmaceutical manufacturers to prevent the risk of defects
The FDA has released a draft guideline that will allow pharmaceutical manufacturers to more accurately report disruptions to the production of drugs and APIs.
In particular, it specifies who should contact the regulator in case of a failure in production and on which products it is necessary to transmit information.
The U.S. Food and Drug Administration (FDA) has issued draft guidelines to pharmaceutical manufacturers to prevent the risk of flaw.
According to the instructions, they will notify the agency of changes in the manufacturing process of drugs, biological products or active pharmaceutical ingredients (API).
In the United States, FD & C. It requires manufacturers to notify the agency of interruptions in the supply of products or APIs.
The FDA ’ s new guidelines provide clarifications.
Manufacturers must submit a notice to the FDA at least six months before stopping drug production, which could lead to their shortages on the market.
If it is not possible to notify the agency six months in advance, it should be done “as soon as possible ”.
If interruptions in production may affect the supply situation, the manufacturer should assess the situation only on the basis of its capabilities.
It should not take into account the capacity of other manufacturers, the amount of product on the market or market demand.
The guidelines also state what specific product or API information manufacturers should report when informing the FDA.
CBS, citing a report from the US Senate, writes that by the end of 2022, the shortage of drugs in the US had reached a five-year peak and affected almost 300 pharmaceutical products.
This is due to the fact that the United States moved production to China, India and other countries.
According to the American Society of Health System Pharmacists, products such as sodium chloride solution, the antibiotic amoxicillin and albuterol inhalation solution are now in short supply.
Nikolay Sokolov
pharmvestnik

US proposes $3.26‑5.11bn over 10 years to address shortages.

EU Commission proposes solidarity mechanism, early warning, joint procurement.

Taiwan 2024 DET policy will adjust drug prices amid war, inflation.

Greece patients search multiple pharmacies or stop treatment due to shortages.

Israeli bombardment in Rafah closed pharmacies, diverted drugs to soldiers.

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Lack of medicines forces Gaza residents to take herbal medicine
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After the majority of medicines ran out of pharmacies, Palestinians in the Gaza Strip resorted to alternatives to treat some of their diseases, such as herbs.
Herbs, or so-called medicine or alternative treatment, have become popular among the population, many of whom are unable to get treatment from pharmacies and hospitals, either because they are shut down and out of service due to Israeli bombing or because many medicines are directed to treat war wounded.
Semi-empty pharmacies
Mohammed al-Sawyer, who lives with his family in the southern Gaza Strip town of Rafah after being displaced from Gaza City, says he began searching for a mixture of herbs to treat intestinal spasms and constipation, which he began to suffer from more than a month ago, after failing to get treatment in pharmacies.
Al-Sawyer told Sky News Arabia: "I was taking a treatment for more than 5 years for constipation, but I did not find it after I searched for it in all the pharmacies of the city," pointing out that he found an alternative treatment in a pharmacy, but does not have any effectiveness in the face of what he suffers.
As for the treatment in the hospital, Sawyer said: "I cannot go to hospitals that are full of patients and wounded around the clock, and in light of the continued Israeli shelling on the city of Rafah, so I did not find an alternative except some herbal remedies."
In turn, pharmacist Khaled Odeh told Sky News Arabia that the majority of pharmacies in Rafah have become empty of the most basic types of medicines, including painkillers and antibiotics, due to the population density in the city, which includes about 1.4 million Palestinians.
According to Odeh, most pharmacies only open their doors to sell some health items to women and children if available, and some cosmetics, of which quantities are still present in the sector.
Growing interest in herbs.
As a specialist in the field, Dr. Nasser Hassanein, an Indian herbal expert and director of the Rafah Herbal Medicine Center, confirms that there is an increasing demand in the Gaza Strip for alternative medicine or herbal treatment, and this demand has become more noticeable during the ongoing war on the Strip.
Hassanein added to Sky News Arabia that "he found a need for his center more with the continuation of the war, which prompted him to activate communication electronically through groups on the application of WhatsApp, to answer as much as possible of the inquiries of those in need of treatment without receiving any payment."
Electronic communication also helped the Palestinian herbalist to increase his expertise by expanding his contacts with specialists in the same field.
Hassanein said: “I have collaborated with experienced herbalists in Yemen, Iraq and Jordan who volunteered for free to answer queries about some of the most common diseases and symptoms among Palestinians in the Gaza Strip. ”
Among these diseases, which have been particularly linked to the war, Hassanein explains, are those related to the digestive system, and caused by the types of canned food that increased dependence, because of its preservatives, after the traditional cooking dishes fresh consisting of meat, fish, fruits and vegetables became scarce amid displacement or high price.
Hundreds of thousands of Palestinians have been displaced from cities in the northern and central Gaza Strip under Israeli shelling of homes there, which has continued since the outbreak of the war on October 7.
Doctors are trying to search for recipes of available herbs that are easy to obtain, Hassanein said, pointing out that “types of herbs are no longer available in Rafah because they were cultivated on agricultural land in the center and east of the Strip, and it is now difficult for farmers to reach them because of their proximity to the border and the presence of Israeli army vehicles that fire on farmers constantly. ”
Hassanein continued: "We are forced to give alternative herbs from the available, even if they are less efficient, and we rely on what we know is available to the perfumers in the city."
According to the pharmacist Odeh, "herbal treatment or alternative medicine needs to be monitored by competent authorities, especially since this type of herbs often does not take into account the differences between pathological conditions and the extent of symptoms that can cause them."
Skynews
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