Antibiotic supply chains need a cure as they face issues of ‘excess and access’

Antibiotic supply chains are on the brink of collapse, cautions The Netherlands-based Access to Medicine Foundation (AMF), as the world grapples with the peculiar problem of ‘excess and access’ when it comes to these drugs.

“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 a report on the “Shortages, stockouts and scarcity” issues on antibiotic supplies.

The report was released in Amsterdam on Thursday. It comes even as governments across the world deal with anti-microbial resistance (AMR), a fallout of irrational or excessive use and abuse of antibiotics. Parallel to this narrative, though, is the other reality in many countries where people are unable to access the antibiotics they need.

‘Global push’

The situation has become worse because drug companies feel “dis-incentivised” and are leaving the market, Jayasree K Iyer, Executive Director, AMF, told BusinessLine. Explaining the tricky cycle, she said the sale of antibiotics was being restricted to control resistance to the drug, which could arise out of excessive use. 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.

“The only way to prevent companies from leaving the market entirely was to make it viable for them, she said. “Without a global push to address the systemic causes, we risk being unable to treat common infections 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.

According to an IQVIA report last year, India consumed more than 260 crore packs or ₹15,000 crore worth of antibiotics in 2016, making it one of the world’s largest consumers of antibiotics. And in the country, Goa, Delhi, Uttar Pradesh, Punjab and Kerala topped the list of antibiotics consumers, with consumption patterns higher than the national average of about 6 packs per 1000 people per day.

Market mechanics

Another factor contributing to the twin 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 antibiotic piperacillin-tazobactam,” the paper pointed out.

Drug companies are not drawn to produce antibiotics, the paper said, “because R&D is risky and expensive, antibiotics offer slim margins, and growth in demand comes mainly from poor countries. Global demand for antibiotics roseby 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,” 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.