New Report Highlights Issues in Global Antibiotics Supply Chains

A report by Amsterdam-based Access to Medicine Foundation (AMF) has claimed that the global antibiotics supply chains are on the brink of collapse putting basic healthcare at risk.

“Between 2001 and 2013, 148 national antibiotic shortages occurred in the United States alone. In 2010, 15 countries reported national shortages of injectable streptomycin, jeopardising the treatment of tuberculosis patients. An ongoing penicillin shortage is currently affecting at least 39 countries, including Brazil, Germany, the Netherlands, the US and India,” the Foundation said in the report titled ‘Shortages, stockouts and scarcity: the issues facing the security of antibiotic supply and the role for pharmaceutical companies’.

Even as Governments across the world deal with anti-microbial resistance (AMR), a fallout of irrational or excessive use and abuse of antibiotics, patients in many countries are unable to access the antibiotics they need.

The situation has become worse because drug companies feel “dis-incentivised” and are leaving the market, said Ms. Jayasree Iyer, Executive Director, AMF. Explaining the tricky cycle, she said the sale of antibiotics was being restricted to control resistance to the drug. And, since sale volumes were low, drug companies did not feel incentivised to make the medicine. Besides, the pricing on these drugs is also much lower than a cancer drug commands.

“Antibiotic shortages are occurring because the antibiotics market just doesn’t work well enough. Pharma companies need to be incentivised to keep producing antibiotics. There is definitely no easy fix. But without a global push to address the systemic causes, we risk being unable to treat common infections, such as from contaminated food or simple wounds,” she said.

An estimated 70 per cent of bacteria is already resistant to at least one antibiotic that is commonly used to treat them. Left unchecked, AMR could stop antibiotics from working within a few decades, the white paper cautions, even as the recently- hosted World Health Assembly singled it out as a key priority.

Antibiotic supply chains are complex. Batches are passed between multiple distributors before reaching the patient, the foundation said. This leads to low visibility and accountability, with little alignment to ensure supply matches demand, it said.

Market mechanics

Another factor contributing to the antibiotic problem is the dependence on two markets – China and India – for active pharmaceutical ingredients (API). Since the APIs are produced at a few factories, a single manufacturing failure has ramifications. “For example, an explosion at a Chinese factory in 2016 triggered an ongoing global shortage of the key broad-spectrum anti-biotic piperacillin-tazobactam,” the paper pointed out.

Drug companies are not drawn to produce antibiotics, the paper said, “because R&D is risky and expensive, anti-biotics offer slim margins, and growth in demand comes mainly from poor countries. Global demand for antibiotics rose by 65 per cent between 2000 and 2015. Four of the six countries with the highest antibiotic consumption rates were low or middle-income countries.”

“There should be a market mechanism to get companies back to producing antibiotics,” Ms. Iyer said, backed by a strategy to procure greater volumes of old or new antibiotics. The international community should “take a unified approach to fixing the market, ensuring that there are multiple suppliers competing at critical links in the chain,” the note said, laying the responsibility at the doorstep of both the government and industry.