Council attributes lack of drugs to commercial interests and low investment

The shortage of medicines experienced by Brazilian patients has causes that go beyond the difficulties imposed by the Covid pandemic and geopolitical changes, and is one of the aspects that the CFF (Conselho Federal de Farmácia) intends to address in the meeting with the rapporteur for the 2023 Budget, Senator Marcelo Castro (MDB), scheduled for this Wednesday (23).

The most recent survey on the medication deficit, carried out by the CFF between July 20 and September 6 with 671 pharmacists across the country, indicates the shortage of antimicrobials (a category that includes antibiotics), mucolytics, antihistamines and analgesics both in the public as well as the private sector.

The shortage of antimicrobials was pointed out by 95.1% of pharmacists, with emphasis on the lack of products such as amoxicillin, metronidazole, clarithromycin and azithromycin. Previous research already highlighted the absence of antibiotics on the market and the study shows that the problem persists.

The lack of mucolytics, a class that brings together expectorants such as acetylcysteine ​​and carbocisteine, was pointed out by 81.2% of professionals. The lack of antihistamines (antiallergic) such as loratadine, prednisolone, desloratadine, prednisone, dexamethasone and hydroxyzine was reported by 76% of respondents. And the absence of analgesics such as morphine or even ibuprofen, paracetamol and dipyrone was described by 70% of pharmacists.

According to Gustavo Pires, general secretary of the CFF and coordinator of the survey, the lack of medication used in cases of flu and cold tends to be seasonal. It is aggravated in the winter months, when consumption naturally increases, and it occurs mainly in the states of the South and Southeast.

In addition, there is a history of prioritizing adult remedies. As the market is larger, industries prefer to invest in this population rather than manufacture products for children, which contributes to the lack of syrups, for example.

Another aspect, says Pires, was the time taken to start immunizing children against Covid. Susceptible to the disease, they demanded more medication.

The survey also reveals the lack of items such as antidepressants, anxiolytics, anticonvulsants, antihypertensives, local anesthetics, contraceptives and saline – the latter missing due to problems related to the manufacture of packaging.

The main reasons given by respondents for shortages are market shortages, unexpected high demand, supplier failure and impractical high prices. Factors such as the War in Ukraine, the Covid pandemic and the lack of raw materials did not reach 1% of the responses.

In a technical report released on Tuesday (22), the São Paulo Regional Council of Pharmacy and the São Paulo State Health Department address the possible causes for the problem.

They point out, on the one hand, the context: closure of ports and airports because of the War in Ukraine and the pandemic, restricting access to mostly imported active ingredients, increased freight rates and reassessment of production from a commercial point of view. On the other hand, they emphasize the abrupt increase in demand.

Data on the discontinuation and reactivation of manufacture and importation of medicines by Anvisa remind us, however, that the fluctuation in supply is not restricted to the pandemic years.

In 2018, for example, 1,108 drugs were temporarily discontinued and 882 permanently in the country. In 2019, those numbers jumped to 1,913 and 1,142, respectively.

Among the possible explanations for the market movement, Pires lists the acquisition of small industries by sector giants and the investment in more up-to-date or more profitable products.

He recalls that the industry is based on certain factors to determine the supply of drugs on the market. One is the commercial aspect. In the country, prices are set by the CMED (Medicines Market Regulation Chamber) and the readjustment is annual. If an industry considers that the value limit expressed in the table is not financially advantageous, it can choose to stop supplying or stock the product. That’s what happened recently with injectable dipyrone.

“The product was stored for weeks and the sector began to pressure the government for the CMED table to be made more flexible”, says Pires. The easing consists of suspending the maximum price for purchasing medicines at risk of shortages in the market and is valid until December 31, months before the annual readjustment and coinciding with the change of government.

This Wednesday (23), the entity has a meeting with Senator Marcelo Castro to try to secure more resources for Farmácia Popular in 2023 —the program has been the target of cuts in recent years—
and hopes to discuss with the transition team ways to ease the shortage.

For CRF-SP and the state secretariat, managers can reduce shortages with centralized purchasing, purchasing larger volumes of medication and correctly considering the delivery time in each region.

For CFF, the way forward is to invest in scientific research in the country, retaining and attracting scientists; to use and optimize the official industries, such as the Pharmaceutical Laboratory of Pernambuco; and negotiating with India and China, the major suppliers of active principles, more advantageous agreements that take into account external impacts.

“When the war in Ukraine started, we saw the government mobilize to guarantee fertilizers for agriculture. We did not observe this same behavior in relation to medicines”, says Pires.

“The change of government is always a moment of hope. We hope that the situation regarding supply can improve.”