“There is no rational debate on the issue of rising drug prices”

bastard! :you go back to your job How much does our life cost?, co-written with Pauline Londeix, about a risk that weighs heavily on our healthcare system, but about which we rarely talk, that of drug shortages. What is the risk today in France?

Jerome Martin


Jerome Martin : According to official data from the National Medicines Agency, we went from just over 400 notifications of strain on a product in 2016 to more than 2,400 notifications in 2021. We therefore see that the risk of shortages is increasing. There was, of course, the Covid effect of increased demand for certain substances that may have heightened tensions. For example, we ended up with intensive care units that no longer had essential drugs such as sedatives and curare, mainly because 80% of pharmaceutical production is located in China and India, and China has halted its production due to the impact of Covid on the country. This clearly shows our dependence.

But we must first think of Covid as revealing all the weaknesses of the system, linked to the relocation and the inclusion of drug production in the commercial logic. Patent holders favor the security of supply chains for drugs that they consider more profitable, usually newer and more expensive products, over drugs that, while essential, are less financially attractive. These shortfalls can result in a real loss of recovery chances for patients and increased time spent on hospital staff trying to find solutions.

Is there a national agency or organization in France responsible for supervising the supply of medicines?

The National Medicines Safety Agency (ANSM) is responsible for monitoring shortages. But it is hospitals, pharmacies and also companies that place orders, with distribution networks. Hospitals and pharmacies must report tensions or shortages of medication to the ASNM. In the last ten years, legislative changes have been adopted to strengthen this reporting obligation. In 2019, a common-sense measure was adopted as part of the Social Security funding law: oblige manufacturers to keep stocks of medicines. However, it was reduced by the implementing decree: the four-month storage obligation was reduced to two months.

When voltages and shortages are communicated to it, it is up to the ANSM to coordinate the action with the manufacturers who must present their response plan. This implies, among other things, that the State is able to identify other sources of supply. But can he pay? There is immense opacity in production capabilities. When alternative treatment solutions exist, the ANSM must check their quality, promote them, ensure that patients are informed of any changes in dosage or form: this takes the time of patients, their associations, their doctor. When there is no alternative supply solution, the ANSM cannot do anything.

The pharmaceutical production system should be competitive, but in fact there is a lot of concentration. If one supplier experiences stresses in a product, there is a good chance that another supplier of the same product will experience the same type of difficulties if the cause of the shortage is related to the production of the raw material. Hence the need to think about relocating production at a European level: there must be manufacturing sites for the same products in different European countries, integrating the production of active ingredients.

Who is responsible in France for negotiating drug prices with pharmaceutical companies?

It is the Economic Committee on Health Products (a body under the Ministries of Health and Economy, editor’s note) that will negotiate this price with manufacturers, based on the industry’s claims. It is, therefore, the manufacturers that open the game of tariffs. However, the committee’s knowledge is considered insufficient to make a rational decision. He does not have at hand the essential elements to negotiate a price: he does not know the real cost of production, how much the industrialist has actually invested in research and development, nor the value of public money received by the company to develop the product. Without more transparency about this, the public authorities cannot assess whether the price requested by the manufacturer is legitimate or not. The latter holds a patent, therefore a monopoly, and has extreme power to set the price as it sees fit.

How could these problems be resolved by creating a public drug production center, a claim you are making to the Observatory on Transparency in Drug Policy?

How much does our life cost?  Research on Drug Policy, Pauline Londeix, Jérôme Martin, issues 18/10.

Much has been said since Covid about a reallocation of pharmaceutical production. If we stick to private relocation, we will remain subject to the law of the market. This will not solve the main problem of drug commodification. In addition, a public medicine center must be supported by health planning and, therefore, by the assessment of short, medium and long-term needs, by the State and all public health actors. This can be a way of preventing scarcity, but also of rebalancing the balance of power. We see the example of Brazil, where the production of medicines by public companies is a strategic tool in price negotiation.

As national and international legislation allows us, under certain conditions, to raise drug patents, a public medical center makes it possible to manufacture products that the country needs. This country can say to the industrialist: “If you don’t lower the price, we will manufacture this drug ourselves. »

Is this idea of ​​a public drug hub gaining ground at the political level in France?

Caroline Fiat (La France insoumise deputy) introduced a bill in June 2020, which was rejected by the majority. Laurence Cohen’s account [sénatrice PC] in the Senate was also contested. A form of dogmatism persists in the pharmaceutical industry, despite Covid. The raison d’être of our book is to provide an accessible tool for these issues to finally be at the center of debate.

To resume debates on health policy and health spending, citizens must have access to knowledge. We spent the entire summer seeing the damage of austerity at the hospital, with the closure or restrictions on access to emergency services. For 25 years we have accepted the pressure on health expenditures, including when it affects the quality of the hospital, but we have not had a rational and citizen debate on the issue of rising drug prices.

And that, even today, despite Covid, which was a somewhat forced initiation for the general public to issues that we already knew as activists in the fight against AIDS, and that patients and populations of southern countries. Furthermore, this idea of ​​a public drug hub is a solution that comes from countries in the South.

If these issues were discussed more widely, based on accurate knowledge, would that in your opinion help fight the wave of anti-medical mistrust of the anti-vaccine movement?

Transparency is a public health tool in its own right. At OTmeds, we distinguish between entrepreneurs of ignorance and fear, who have a specific political agenda, and people who ask themselves questions. The opacity of the drug chain sets the stage for entrepreneurs of ignorance. It is because we did not do what was necessary, with the necessary transparency at the time of launching the vaccination campaign, that we pushed people who were asking into our arms.

The “inflation reduction” law passed this summer in the United States contains a measure to control drug prices. Do you think this is a sign that the situation is changing on the matter?

We should wait to have a little perspective to see what the effects of this law will really be, in any case it is a sign that politics can intervene, that a balance of power is possible. The context is very different in the United States, as it is essentially private groups that are responsible for health coverage. There are very strong mobilizations from patients, about the price of insulin, for example: it is sold at prohibitive prices, while it is a molecule that we have known for 100 years. Diabetic patients, without health coverage, do not have access to it or have to reduce their doses because of the price.

We are not in the same situation in France. But we have political leaders who tell us that we spend too much on health and who use this discourse to dismantle public health services instead of asking whether drug prices are legitimate.

In the United States, again, the patent war is now raging between Covid vaccine companies, with Moderna attacking Pfizer and BioNTech in court in late August, and the lawsuits against Moderna and Pfizer launched by others. companies…

It’s not new. It happened in other cases with other diseases, in particular with products considered very innovative. Since intellectual property becomes one of the pillars of this commercial and financialized pharmaceutical system, it is not surprising that those who benefit from this system try to extract the maximum benefit from it.

On the contrary, we want every citizen to have the opportunity to assess the legitimacy and relevance of this monopolization of profits by the companies holding the patents. Our taxes contribute to fund the development of patented products: through basic research, research tax credit, reimbursement of medicines through health insurance, aid to innovative young companies that have benefited from industry start-ups and other public assistance. which is tolerance for tax evasion. These lawsuits should not make us forget that the main problem is the inclusion of pharmaceutical research in the commercial logic.

Given what we know about the emergence of new infectious risks, linked, among other things, to deforestation and intensive livestock farming, the system as it is, by privileging the private sector and profiting in the short term, cannot meet our needs . This goes beyond a moral issue, although profiting while people are dying is questionable. But the question is also: “Does it work to enforce the right to health? » The answer is no.

Today we are confronted with monkeypox. We know that this disease has been affecting Africa for thirty years and is now reaching rich countries. It was completely ignored when it affected very poor populations, because then it was not profitable to develop pharmaceutical responses. Today, we find ourselves with an epidemic in our country that can only be fought with tools designed for smallpox and not smallpox. We wouldn’t be in this situation if we had invested the means when it affected populations in low-income countries.

Collected by Rachel Knaebel

Featured photo: CC Daniel Foster

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