Medicine Shortages in Germany: The Ongoing Supply Chain Crisis and Its Global Implications

Can Europe Overcome Its Growing Medicine Shortages?

For years, Europe has faced growing concerns over medicine shortages, with Germany experiencing a particularly severe impact in recent months. As bottlenecks in the supply chain persist, German hospitals and pharmacies are grappling with critical shortages of essential medicines, from saline solution to antibiotics. Experts predict that relief is not expected anytime soon. The pharmaceutical industry, heavily reliant on active ingredients sourced from China and India, is encountering disruptions that expose the fragility of global supply chains. Moreover, recent changes to China's espionage laws have complicated quality-control efforts, exacerbating fears of more significant shortages. This article delves into the root causes of these shortages, the impact on healthcare systems, and the possible future trajectory of pharmaceutical supply chains, especially in Europe.

Saline Solution and the Ripple Effect
At the heart of the current crisis in Germany is the alarming shortage of saline solution. This seemingly simple and inexpensive product is a staple in hospital settings, used in countless procedures, including surgeries, irrigation, and intravenous infusion. Its absence, however, has raised significant concerns across the healthcare industry.

According to Thomas Preis, the head of the North Rhine Chamber of Pharmacists, the situation has worsened dramatically in recent months. Once restricted to hospitals, the shortage is now affecting outpatient care. "What has already been a major problem in hospitals for months is now also affecting the care of outpatients," Preis told the Rheinische Post, a German newspaper.

The North Rhine-Westphalian Ministry of Health has echoed these concerns, confirming that hospitals in the region had only received 80% of their required saline solution supplies for several months. This has since dropped to just 50%, and officials from the Federal Institute for Drugs and Medical Devices (BfArM) have warned that this problem is likely to persist for months. Saline solution, though inexpensive, is crucial for operations, wound cleaning, and infusions, highlighting how even basic medicines are vulnerable to broader systemic supply chain failures.

Antibiotics and Pediatric Medicine Shortages
Saline solution is not the only drug in short supply. Antibiotics and children's medications have also faced chronic shortages. A 2024 survey by the German Professional Association of Pediatricians (BVKJ) found that a third of its members believed the quality of treatment was at risk due to these shortages. Beyond the impact on health outcomes, the survey indicated that shortages were causing significant delays as doctors now must verify drug availability before prescribing treatments. This additional time spent searching for medicines only adds to the strain on the healthcare system.

The German Pharmacists' Association (DAV) has reported that supply issues now affect around 500 different prescription drugs, further complicating patient care. In response, healthcare providers are being forced to find alternative treatments or rely on less effective medications. The knock-on effects are significant, as delays in treatment can exacerbate health problems and lead to worse outcomes, particularly for children and vulnerable populations.

Europe's Medicine Shortage: A Broader Problem
Germany is not alone in facing medicine shortages. The problem is widespread across Europe. A 2023 survey by the Pharmaceutical Group of the European Union (PGEU) revealed worsening drug shortages in several countries, including Sweden, Portugal, and Spain. This highlights the pan-European nature of the crisis, with many EU countries increasingly relying on a small number of global suppliers, particularly in Asia.

The underlying issue, as experts explain, is that Europe, once a powerhouse in pharmaceutical manufacturing, has seen much of its production shift overseas. In the past, Germany was dubbed the "pharmacy of the world," boasting major pharmaceutical companies such as Bayer, Boehringer Ingelheim, and BioNTech. However, today's pharmaceutical supply chains stretch across the globe, with the majority of active ingredients now produced in China and India. These countries offer lower wages and have less stringent environmental regulations, making them attractive for mass drug production.

But this shift in production comes with risks. As Professor David Francas, a supply chain expert from Worms University of Applied Sciences, points out, "We are, therefore, dependent on just a few manufacturers. And if one of them gets stuck, then the whole supply chain gets stuck." This became painfully evident during the COVID-19 pandemic, when a closed harbor in Shanghai or a ship blocking the Suez Canal was enough to cause major disruptions.

The issue is further compounded by the industry's adoption of just-in-time production, which minimizes storage costs but leaves little room for errors in the supply chain. Temporary shortages in production, whether due to natural disasters, pandemics, or geopolitical tensions, cannot be easily compensated. As a result, the entire supply chain risks breaking down when even one link fails.

Generics and the Price Problem
The medicine shortage problem is particularly pronounced when it comes to generic drugs, which make up around 70-80% of pharmaceutical supplies. As these medications are cheaper to produce, their margins are slim, leading manufacturers to cut costs wherever possible. This often means fewer suppliers, greater dependence on overseas production, and minimal storage of stock. With discount agreements and other deals pushing prices even lower, it becomes increasingly difficult for manufacturers to absorb shocks in the supply chain without passing costs onto consumers or halting production altogether.

This leads to the question of whether Europe can re-establish some of its pharmaceutical production to reduce its reliance on foreign suppliers. While many have called for the return of drug manufacturing to the EU, doing so presents several challenges. One significant obstacle is environmental legislation, which makes it nearly impossible to produce the fine chemicals required for active ingredients in Europe. As Professor Ulrike Holzgrabe from the University of Würzburg explains, "We have created environmental legislation that makes this almost impossible." Even if production were to be re-established in Europe, it would take at least five years to build the necessary infrastructure, meaning any solution would not be immediate.

A New Threat: China's Espionage Laws and Their Impact on Drug Supply
In addition to the existing supply chain issues, the pharmaceutical industry is now grappling with a new threat: China’s tightened espionage laws. Four of Germany's 16 states have already canceled their routine quality-control trips to Chinese pharmaceutical factories out of fear that inspectors could be at risk of violating China's new anti-espionage regulations.

China is one of the world's largest suppliers of active pharmaceutical ingredients (APIs), and Germany imports nearly 90% of its antibiotics from the country. The decision to halt inspections, therefore, poses a major risk to Germany's drug supply. Without inspections, active ingredient certificates that confirm manufacturing processes meet EU standards could expire, threatening the entire supply chain.

Andreas Aumann, a spokesperson for the German Pharmaceutical Industry Association (BPI), has expressed concern, warning that "No one can afford additional drug shortages." He emphasized the importance of maintaining regular inspections to ensure the continued flow of drugs from China. The BPI has appealed to the German government for assurances that inspectors can safely resume their work in China, but the situation remains unresolved.

Meanwhile, Dorothee Brakmann, CEO of Pharma Germany, has echoed these concerns. Speaking to German media, she described the current situation as precarious, with inspectors fearing the possibility of arrest or reprisals while conducting routine quality checks. The fact that China has introduced broad, vague terms like "work secrets" into its anti-espionage laws has further complicated matters, leaving foreign companies uncertain about what information they are allowed to collect.

Although China's government has attempted to downplay concerns, insisting that the new laws will not interfere with normal business activities, the lack of clarity has left many in the pharmaceutical industry on edge. Mao Ning, a spokesperson for China's Foreign Ministry, stated that "As long as the relevant companies and personnel can act in accordance with the law, there is nothing to worry about." However, several foreign business organizations have called for greater clarity on what constitutes a violation under the new laws.

The Future of Europe’s Pharmaceutical Supply Chains
As the supply chain crisis deepens, Germany and other EU countries face difficult choices. The COVID-19 pandemic exposed the vulnerability of relying on foreign production for essential medicines, and now, with tightened regulations in China, these weaknesses have been further exacerbated. Some industry experts argue that Europe needs to take bold steps to bring back pharmaceutical production to the continent. Others, however, acknowledge that this is a long-term solution that will take years to implement.

In the short term, governments will need to navigate the challenges posed by geopolitical tensions, environmental regulations, and just-in-time production models. Collaboration with international partners will be key to maintaining a steady flow of essential medicines, while efforts to diversify supply chains could help mitigate the risks associated with dependence on a few large manufacturers in Asia.

For now, patients and healthcare providers in Germany and across Europe will need to brace for further disruptions. The shortages of antibiotics, saline solution, and other vital medicines will likely continue in the coming months, forcing hospitals and pharmacies to ration supplies and search for alternatives. As the pharmaceutical industry navigates this complex landscape, it will be crucial for policymakers, manufacturers, and healthcare providers to work together to find sustainable solutions.