Shortage of antibiotics, painkillers puts Brazil’s pharmacists on alert

RIO DE JANEIRO, BRAZIL – Shortages of certain groups of medicines, such as antibiotics or painkillers, especially for children, have put Brazilian pharmacists on alert, and they are calling on the government to intervene to break the logistical logjam, which is exacerbated by shortages in China and the war in Ukraine.

The problem is “worrying” and affects “the whole country,” although to varying degrees depending on the region, Gustavo Pires, secretary-general of the Brazilian Federal Council of Pharmacy (CFF), told Efe.

The first warnings appeared in hospitals at the end of 2021. For the past month and a half, they have been a reality in pharmacies, which have reported increasing difficulties in replenishing stocks of medicines such as antibiotics or painkillers, especially for children.

THE SOURCE OF A “PERFECT STORM”

Demand in the country of 213 million is rising rapidly, coinciding with the onset of the Australian winter in the southern half and an increase in dengue and Covid 19 cases.

“All of this creates a perfect storm,” Marcelo Polacow, president of the Regional Pharmacy Council of São Paulo, the country’s most economically significant state and one of the hardest hit, told Efe.

The root of the problem lies primarily in severe imbalances in global production and distribution chains.

Thanks to an expanding industrial park, Brazil produces about 70% of the pharmaceuticals it consumes but imports more than 90% of the raw materials needed to manufacture them, mainly from India but mostly from China.

The importation of these active ingredients is now causing headaches. Recent restrictions in China due to Covid-19 have worsened the situation, with factories closed and important ports like Shanghai operating incredibly difficult.

The war in Ukraine has exacerbated the international logistics crisis, driving up transportation costs – rising fuel prices, shortages of containers…. – which have been dragging on since the pandemic.

“If the input doesn’t arrive, I can’t produce, I can’t distribute, and it doesn’t get to the end of the line,” Polacow says.

But there are obstacles not only in getting those inputs but also in getting essential parts for manufacturing and even packaging certain drugs.

One example. The manufacture of some injectables requires water with a high degree of purity, obtained with “ultra-mega-special and costly filters,” of which the world’s largest producer is the United States, Pires says.

Polacow points out that since the outbreak of war in Ukraine, the U.S. has curtailed exports because it feared its domestic market would not be supplied.

DIFFICULTIES IN SAO PAULO AND OTHER STATES

As a result, 98.5% of the more than 1,100 pharmacists surveyed in the state of São Paulo “suffer from a shortage of certain medicines in both public and private networks,” according to a survey released last Monday by the Regional Council of Pharmacy.

Of this group, almost all (93.5%) reported a shortage of antibiotics, with amoxicillin and azithromycin being the most frequently mentioned. Many said mucolytics, antihistamines, and painkillers such as metamizole, ibuprofen, or acetaminophen.

Locally, pediatricians in the capital city of São Paulo have “big problems” prescribing antibiotics and cough syrups, according to one pediatrician who declined to reveal his identity.

“And this shortage is widespread throughout Brazil, not just in São Paulo,” warns Polacow, who counts Minas Gerais, Rio de Janeiro, Pernambuco, and Goiás, among the states also facing difficulties.

For this reason, Pires calls on the government of Jair Bolsonaro to “act” with an “assertive foreign policy” and negotiate with producing countries “a minimum guarantee” for these medical supplies, as it did in securing the supply of Russian fertilizers for the agricultural sector.

INDUSTRY CALLS FOR PRICE LIBERALIZATION

The Brazilian pharmaceutical industry reduces the problem to “specific issues” and rules out a structural shortage, according to Reginaldo Arcuri, executive president of the FarmaBrasil Group. This association brings together the sector’s leading national companies.

And they, too, have their demands.

Arcuri points out that drugs such as injectable metamizole are no longer profitable due to rising costs and the fact that there is no “free pricing” of medicines in Brazil; instead, the price is set by the government, and some national manufacturers have stopped production.

In response, the Brazilian Chamber for the Regulation of the Pharmaceutical Market – an inter-ministerial body – issued a resolution on June 1 temporarily liberalizing the prices of drugs “at risk of shortage in the national market,” which is expected to hit Brazilians’ pockets.

With information from EFE

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