News

Media And Political Bulletin – 16 April 2020

Media and Political Bulletin

16 April 2020

Media Summary

Local pharmacies face cash crisis

BBC News, Simon Read, 16 April 2020

Working life for pharmacists has change considerably since the lockdown, BBC News heard from Dai Williams, who runs two pharmacies in Rhondda in South Wales.

He highlights that thousands of independent community pharmacies across the country are facing a cash crunch, because the wholesale price of medicine has shot up, cutting margins and putting financial pressures on. Meanwhile, longer hours and twice as many deliveries have meant higher staff costs. For him, the biggest issue has been a sharp rise in demand for prescriptions.

And he says the net result could be closures, leaving communities around the country with no local chemists.

Coronavirus: Three quarters of public favour working with EU to get vital protective equipment

Independent, Lizzy Buchan, 16 April 2020

More than three quarters of the public think the UK should participate in EU schemes to secure vital protective equipment, as it emerged ministers passed on three opportunities to take part.

A new poll by Focaldata for Best for Britain found 77% of people favoured staying in the European Medicines Agency (EMA) and other EU agreements to help battle the coronavirus outbreak.

It comes amid reports the UK missed out on three chances to participate in EU schemes to bulk buy PPE, which is subject to huge demand from NHS and care staff battling the virus.

Therese Coffey, the work and pensions secretary, insisted that the government had “sufficient stocks” despite warnings by medics and care workers of a shortage of equipment.

Ways to safeguard UK drug supplies during COVID-19 and beyond

The Pharmaceutical Journal, Andrew Hill, 15 April 2020

Even before the COVID-19 pandemic, pharmacy was no stranger to medicines shortages. However, medicine supply chains in several countries are now being stretched to breaking point.

In the UK, the COVID-19 pandemic is stretching the NHS, including its supplies of essential drugs, to the limits.

Andrew Hill, honorary senior visiting research fellow at the University of Liverpool’s Department of Translational Medicine and adviser to World Health Organization says we may need new systems in place to ensure patients never miss out on medicines they need.

According to Hill, the UK supply chain is weak — and he argues that we need three new systems in place to protect our access to medicines, both during the pandemic and in the future, explored in this opinion piece.

 

 

Parliamentary Coverage

There was no parliamentary coverage today.

 

Full Coverage

Local pharmacies face cash crisis

BBC News, Simon Read, 16 April 2020

“The last month has been the hardest of my 35 years in pharmacy,” said Dai Williams.

He runs two pharmacies in Rhondda in South Wales and while demand has increased massively since the lockdown, that’s not been good for business.

That’s because the wholesale price of medicine has shot up, cutting margins and putting financial pressures on.

Meanwhile, longer hours and twice as many deliveries have meant higher staff costs.

Thousands of independent community pharmacies across the country are facing a cash crunch.

The net result could be closures, leaving communities around the country with no local chemists.

Sharp rise in prescriptions

Working life for pharmacists has change considerably since the lockdown, said Dai Williams.

“Many of my colleagues have had to shut for a couple of hours during the day just to cope with the extra demands,” he reported.

The biggest issue has been a sharp rise in demand for prescriptions.

Making up the medicine is already time-consuming, but currently takes longer because staff are wearing protective equipment.

Social-distancing has also had an effect.

“I have a member of staff going round to doctors surgeries to pick up repeat prescriptions, return to the pharmacy to dispense them, and then deliver them to vulnerable members of the community,” said Mr Williams.

The number of deliveries has doubled since the lockdown from 40 to 80 a day.

“We have to cope with the extra work and stress, it’s simply what we have to do,” he said. “But it’s been tough,” he admitted.

Counting the cost

Pharmacies aren’t cashing in from the extra business as many supply prescriptions at a loss.

That’s because the NHS drugs tariff, which pharmacies receive for selling generic prescription drugs, is often lower than the prices suppliers demand.

That raises the prospect of heavy losses, especially for the majority of community pharmacies that make around 95% of their income from the NHS.

“Suppliers have increased prices since the lockdown,” said Mark Burdon, who operates five independent pharmacies in Tyne and Wear.

“The price of paracetamol wholesale climbed from around 50p to £2,” he said.

The ramp in the price of hydroxychloroquine – the malaria drug mentioned by Donald Trump as a possible Covid-19 cure – was even more dramatic.

“It used to cost us £2. Now it costs up to £32.49,” Mr Burdon said.

Paid in arrears

The surge in demand and higher prices has left Mr Burdon’s practices facing a drugs bill more than 50% higher in March than the previous month, which creates its own problems.

“We are effectively paid a couple of months in arrears by the NHS, and we have to pay suppliers before we get the money back,” he explained.

“Pharmacies are geared up for that but not these sudden extra charges, which could cause huge cashflow problems for some.”

Mr Burdon is one of the regional representatives of the Pharmaceutical Services Negotiating Committee.

He reckons the government should earmark emergency cash to help pharmacies stay afloat.

“The case has been proven for investment in the community pharmacy service as the front door to the NHS, supporting self-care and keeping people away from their GP or the hospital,” Mr Burdon said.

Behaviour problems

Meanwhile workers at pharmacies have reported a rise in aggressive behaviour from frustrated customers, with some reportedly even being forced to hire security guards.

Problems became so severe in one area that they launch a local campaign urging patients to respect pharmacy staff.

“We were getting calls that staff were getting abuse from a small number of patients, such as banging on windows and shouting, with one member of staff even reporting being spat at,” said Kath Gulson, chief officer of Community Pharmacy Lancashire.

“Problems began with the surge in prescriptions at a time when we faced reduced staff because some were forced to self-isolate.”

With pharmacies shutting at times to catch up with prescriptions, plus restrictions placed on the amount of over-the-counter drugs that could be bought, some customers got very angry, she said.

They launched the “Care for your pharmacy so your pharmacy can care for you” campaign.

“We’re just asking customers to understand the different way we have to operate now and support us so we can support the people that need us.”

Coronavirus: Three quarters of public favour working with EU to get vital protective equipment

Independent, Lizzy Buchan, 16 April 2020

More than three quarters of the public think the UK should participate in EU schemes to secure vital protective equipment, as it emerged ministers passed on three opportunities to take part.

A new poll by Focaldata for Best for Britain found 77 per cent of people favoured staying in the European Medicines Agency (EMA) and other EU agreements to help battle the coronavirus outbreak.

Brexit divisions were put aside in the face of the crisis, with 57 per cent of Leave supporters favouring working with Brussels to help the UK buy and develop medicines, vaccines, tests and protective equipment.

The move also attracted cross-party support, with six out of ten (62 per cent) Conservative voters backed working with the EU, as well as 37 per cent of Brexit Party supporters.

Nearly nine out 10 (88 per cent) of Labour voters agreed, rising to 95 per cent among Liberal Democrats.

It comes amid reports the UK missed out on three chances to participate in EU schemes to bulk buy personal protective equipment (PPE), which is subject to huge demand from NHS and care staff battling the virus.

Downing Street previously claimed it had failed to join the scheme due to a missed email, but it has now emerged that British officials in Brussels took part in four meetings in March during which bulk-buying was discussed, according to EU minutes reported by The Guardian.

Three rounds of procurement have since taken place, with European medics preparing to receive the first batch of €1.5bn (£1.3bn) of PPE within days. The European Commission says it is receiving more kit than it ordered.

Therese Coffey, the work and pensions secretary, insisted that the government had “sufficient stocks” despite warnings by medics and care workers of a shortage of equipment such as gloves, masks and gowns.

“The government has made an assessment that by joining the schemes, it wasn’t going to make any particular difference to the procurement of PPE,” Ms Coffey told LBC earlier this week.

“That’s still our basis of whether or not we attended a meeting in February or whether we attended the meeting in March. That’s still the outcome.” ​

But Naomi Smith, chief executive of Best for Britain, said: “We cannot go on like this. The medical professionals who are risking their lives to save others deserve much better.

“The government must take every opportunity it can to source important medical supplies and urgently seek participation of collaborative EU efforts if they can deliver the PPE we need.”

Layla Moran, Lib Dem MP and leadership candidate, told The Independent: “At a time when NHS staff are facing shortages of life-saving equipment, it is simply unforgivable that opportunities to take part in these EU schemes were missed.

“Serious questions will have to be answered in due course about whether this occurred as a result of ideology or incompetence.

“For now the focus must be on ensuring the NHS does not miss out again in future. Ministers must therefore urgently clarify whether the UK will participate in future EU schemes to secure the equipment our health service needs.”

Meanwhile, British and EU negotiators have agreed to stage further talks on a post-Brexit trade deal as the government insists on pressing ahead with its Brexit timetable.

David Frost, the UK’s chief negotiator, and his EU counterpart Michel Barnier met by videolink on Wednesday, where they agreed to continue trade talks remotely, with regular virtual meetings scheduled over the next three months.

In a joint statement, both teams said “real, tangible progress” was needed by June on hammering out the major trade agreement needed to prevent a no-deal crash out at the end of the year.

A crunch meeting will be held in June to “take stock of the progress made” as any extension to the transition period must be made by July.

Boris Johnson has repeatedly refused to countenance a delay – despite the pressures of the coronavirus outbreak, which has decimated the negotiating teams. Mr Barnier contracted coronavirus and has now recovered, while Mr Frost was forced to self-isolate after displaying Covid-19 symptoms.

Focaldata polled 2093 UK adults online between 7-9 April. Data are weighted.

Ways to safeguard UK drug supplies during COVID-19 and beyond

The Pharmaceutical Journal, Andrew Hill, 15 April 2020

The COVID-19 pandemic is stretching the NHS, including its supplies of essential drugs, to the limits. We may need new systems in place to ensure patients never miss out on medicines they need.

Even before the COVID-19 pandemic, pharmacy was no stranger to medicines shortages. However, medicine supply chains in several countries are now being stretched to breaking point.

In the United States, supplies of essential medicines for patients with coronavirus are running low. Medicines used for sedation and pain management are in high demand; for example, orders for fentanyl, midazolam and propofol have increased by 100%, 70% and 60%, respectively. Demand for albuterol, a common asthma inhaler medicine, has also risen significantly. And, in New York City, pharmacies have reported shortages of basic medicines such as paracetamol and azithromycin.

In Paris, the daily use of some medicines has increased by up to 2,000%. According a colleague — an intensive care clinician based in France — there is a long list of medicines in severe shortage, including anaesthetics, muscle relaxants, antibiotics and neuroleptics. In hospital geriatric and palliative care departments, midazolam and morphine, diazepam, and clonazepam are in short supply.

Meanwhile, at the time of writing, a group representing nine major hospitals in Europe — including King’s College Hospital in London — have warned of shortages of important intensive care medicines, such as muscle relaxants, sedatives and pain-killers within two weeks by mid-April 2020 if new measures are not taken.

Supply chain disruption

It should be possible to meet these demands if supply chains are stable. However, the COVID-19 pandemic has disrupted supplies of several essential drug ingredients and manufactured drugs from China and India, respectively. And, around 80−90% of the UK’s supply of generic medicines — of which India and China are major producers — is imported from other countries.

Raw materials for many essential medicines — known as ‘active pharmaceutical ingredients’ (APIs) — are manufactured in factories in China. These APIs are then exported to countries such as India, where they are formulated into tablets or injectable drugs for worldwide export and sale. Indian companies procure 70% of their raw materials from China, where manufacturing is cheap. Data suggest that the NHS relies on India for 25% of its medicines.

However, in February and March 2020, the spread of COVID-19 forced some Chinese factories to cease production. The workforce were in quarantine and transport between factories was not possible, so supply of raw materials for medicines was severely disrupted.

Since supply had been disrupted, production in and export from India, and other countries, has dwindled. In response, it was reported on 3 March 2020 that India would provide its own people with essential medicines first. At the time of writing, only excess supplies were being exported to other countries, which would have a detrimental impact on medicine supplies for the NHS in the UK. The ban was reported to have been partially lifted on 7 April 2020, but it is not yet clear when production of the raw materials in China and formulation of the end-product drugs in India will fully resume.

Shortages on this scale

The scale of the disruption to supply chains from the COVID-19 pandemic is unprecedented, with a wide range of medicines affected. It is not the first time there have been global medicine shortages, but previous shortages have been on a smaller scale.

For example, factories near Beijing closed for three weeks in 2008 to minimise air pollution during the Olympic Games, but closing API factories led to global shortages.

Then, in 2018, Hurricane Maria struck Puerto Rico and damaged a factory that manufactured the anticoagulant heparin, which disrupted supplies of the medicine.

Most recently, in 2019, China’s swine flu epidemic saw the deaths of millions of pigs, which led to further shortages of heparin, after shortages of heparin’s active ingredient — which is derived from pig intestines — disrupted production.

The supply chain can also be affected if factories fail regulatory inspections to assure the quality of drug production; for example, reports of contaminated batches of the blood pressure medicine valsartain caused disruption in 2018.

UK medicine stocks

Thanks to planning for a no-deal Brexit, the NHS should have supplies of essential medicines available to ensure that shortages do not occur. And, to protect the NHS’s current supplies, the parallel export of 80 medicines from the UK — including insulin, paracetamol and morphine used to treat patients in intensive care units — was banned on 20 March 2020. A further 52 medicines — including several respiratory medicines, antibiotics, analgesics and insulin products — were banned from export on 1 April 2020.

However, even before the onset of the COVID-19 pandemic, there were reports of shortages of dozens of life-saving medicines in the NHS. In November 2019, a leaked document listed 17 new medicine shortages. The supplies of diamorphine, for example, were “insufficient stock to cover the full forecasted demand in both primary and secondary care”. As of April 2020, diamorphine remains in short supply.

Treatments for COVID-19

The demand for any new treatment for, or vaccination against, COVID-19 is, of course, extremely high. Hydroxychloroquine, which is usually used to treat people with rheumatoid arthritis or systemic lupus erythematosus, in combination with the antibiotic azithromycin, has been thrust into the spotlight as a potential treatment.

However, evaluations of this combination’s efficacy are inconclusive and the European Medicines Agency advises hydroxychloroquine should be used only in clinical trials of patients with COVID-19, or for emergency use, rather than general use. In addition, regular users of the hydroxychloroquine around the world are now facing restricted supplies.

Other medicines are also being evaluated for their use in treating COVID-19, such as the antivirals remdesivir and favipiravir, as well as treatments to improve lung function, such as pirfenidone or tocilizumab. The first clinical trial results for these medicines are expected in May 2020, well ahead of the first preventative vaccines, which are expected in mid-2021.

Many of these medicines are small molecules with very low production costs. If these or similar medicines are effective in treating COVID-19, and if their APIs are manufactured in other countries, there could be international competition for limited supplies. The unproven medicine hydroxychloroquine has already been subject to this competition.

Will supplies be adequate to treat all people with COVID-19 in the UK? Worldwide demand could easily outstrip supply.

How the UK’s supply chain must change

Medicine supply chains are only as strong as their weakest links. If new COVID-19 treatments do emerge, the UK cannot afford to be at the end of long and unreliable supply chains.

Currently, the UK supply chain is weak — we need three new systems in place to protect our access to medicines, both during the pandemic and in the future.

1 Apply stress tests to our supply chains

Following the financial crisis of 2008, stress tests were applied to the banking system. Medicines supply could be tested in a similar way.

If similar tests were applied to the NHS medicine supply chain, they would answer important questions. Questions such as: how many medicines are originally manufactured in China and formulated in India? How would the NHS cope if Chinese supplies continued to be disrupted? For each essential medicine, are there alternative suppliers in other countries? Is there another medicine patients could take, if the preferred is no longer available? What happens if manufacturing in other countries is also affected?

In January 2020, the US Food and Drug Administration started checking the source of APIs for a wide range of essential medicines, soon after the threat of COVID-19 became apparent. The UK should be following similar procedures.

1 Diversify the sources of our medicines

The NHS should also be using at least three different companies in at least two different countries to source its essential medicines. These companies should also use different sources for their APIs.

At the moment, the NHS will typically have at least two different companies to supply commonly used medicines, but these companies might both be relying on the same company in China for their raw materials. This mechanism would protect us from future disruption of the supply chain. Online import−export databases can be used to track the source of raw materials of many medicines, and to ensure that raw materials for all essential medicines are sourced from at least two independent suppliers.

1 Produce medicines and diagnostics in the UK

We must consider manufacturing more medicines and diagnostic tests in the UK, instead of relying mainly on imports. In times of shortage, other countries — such as India — hold on to supplies and reduce exports to treat their own people. We could do the same.

The UK is home to large pharmaceutical companies with world-class expertise in drug development. We have the technical ability to set up the mass production of essential medicines in the UK or other countries, if the supply chains fail in China, India or elsewhere. Additionally, the UK could start production of medicines and vaccines against COVID-19 as soon as the first clinical trials show benefits.

Manufacturing drugs and diagnostic tests in the UK will be significantly more expensive than in China and India: in fact, all the new systems proposed would incur cost and inconvenience. But this is the price we must pay to ensure rapid access to the treatments we need.

Media And Political Bulletin – 16 April 2020

From Factory to Pharmacy

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