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25 Mar 2020

Coronavirus and medicine shortages: what's going on?

It's not just paracetamol. Find out what's behind stock issues, what's being done to tackle the problem and what you can do

Paracetamol and ibuprofen are just some of the items that are increasingly hard to get hold of as people stock up on everyday essentials in the wake of the coronavirus crisis and UK government lockdown.

But even before the pandemic hit, there were issues with prescription medicine shortages in the UK.

We surveyed Which? members in December 2019 and found that one in four people had experienced problems getting hold of the medicines they needed because of stock shortages in the past year.

Pharmacy stocks have always been subject to fluctuations, but these appear to have become worse in the past six months, particularly, and the recent pressure on supplies due to people's fears over coronavirus certainly hasn't helped matters.

Coronavirus and paracetamol shortages

Paracetamol is the main form of relief available for the fever-like symptoms of COVID-19 if you're self-isolating at home. It's also an everyday household medicine that people are buying to prepare for self-isolation.

This increased demand has put stress on supplies - stocks are currently low or non-existent across pharmacies and supermarkets.

Painkillers such as paracetamol and ibuprofen are already subject to limits of how many you can buy in one go, but some stores are now putting even stricter limits in place in an attempt to regulate supply. Boots has now limited customers to just one paracetamol product.

But even so, a pharmacist we spoke to who works at a large Boots store said there were no paracetamol products in stock, and that they were on order but there was no promise of imminent delivery. We've been to several pharmacies and supermarkets and been greeted by empty shelves there too.

COVID-19 and increased global demand

Like hand sanitiser and other household essentials, paracetamol is increasingly hard to find. And there are some concerns about the scarcity of supply.

India, the world's biggest supplier of generic drugs, recently introduced a limit on the export of medicines including paracetamol. The move came as factory shutdowns in China, attributed to the coronavirus lockdown, have fractured the supply chain (India gets most of its raw ingredients for medicines from China).

Hydroxychloroquine, a drug that is vital in treating lupus, is also running low as unproven claims it can cure COVID-19 have sparked increased demand. India - where the drug is manufactured - temporarily stopped all exports of it in order to protect its own supplies, but the ban has since been relaxed.

Update 6/4/2020:the manufacturer of Clenil asthma inhalers has said it is 'seeing a vastly larger number of prescriptions being filled than usual' and 'a dramatic increase in inhaler demand - approximately four times higher than average.' It is thought this is down to people ordering more than they need.

The manufacturer appealed to GPs and pharmacists to 'help maintain supply by continuing to write monthly repeat prescriptions rather than writing prescriptions for multiple inhalers.'

Will prices go up?

In the case of paracetamol, drug wholesalers have passed on increased costs to high street retailers and pharmacies, but bigger chains can usually absorb these costs. Boots told us: 'Customers can be reassured that the cost of their regular brands, including Boots own-brand Paracetamol, has not and will not go up.'

The Pharmaceutical Services Negotiating Committee (PSNC), a representative body for community pharmacists, said that it's 'keeping a close eye on generic medicines (including paracetamol) affected by recent price hikes and is making applications for price concessions [where pharmacies are reimbursed by the government for wholesale price hikes] in the usual way'.

UK government seeks to reassure consumers

Unsurprisingly, people are concerned about the shortages. We asked the Department of Health and Social Care (DHSC) for comment, and a spokesperson told us: 'The country is well prepared to deal with any impacts of coronavirus and we have stockpiles of medicines such as paracetamol in the event of any supply issues or significant increases in demand.

'We are working with suppliers of paracetamol to monitor and assess available supplies and demand, and will continue to do so. Suppliers have informed us that manufacture continues and deliveries are scheduled.'

The DHSC also said that the NHS has stockpiles of paracetamol reserved for use in hospitals, and that paracetamol has been added to a list of medicines that cannot be parallel exported from the UK.

What to do if you're having problems getting hold of paracetamol

If you have a specific medical need for paracetamol and are struggling to find it in stores, speak to your GP or pharmacist to see if they can help you track it down and what options or alternatives are available.

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Why do medicine shortages happen?

The current shortages of painkilling medication can be explained by the coronavirus impact: a toxic combination of massive increase in global demand, disruption to supply chains and people stocking up on things such as food, household products and medicines.

But what about the shortages of other medicines people were already experiencing?

A London GP told us their practice had faced a significant rise in workload because of daily medicine shortages: 'In the past year, we've acquired three part-time pharmacists who are now u201cin-houseu201d to share the load for finding alternatives to medicines in short supply.'

Another GP, based in Surrey, said shortages are affecting all sorts of medicines and they're notified of new shortages almost daily, but with little advice on what to do about them.

It's thought that a couple of different factors have led to the supply issues we're seeing now. These are:

  • Manufacturing and distribution issues If there's an issue with a single ingredient or batch, this can affect the whole supply chain. There may then be a snowball effect as lots of people switch to an alternative, which is then in higher demand.
  • Pricing issues Changes in wholesale prices, the drop in the value of the pound in recent years and what the NHS can afford to pay for some medicines can be another factor.
  • Parallel exports Sometimes medicines on the market in the UK are bought by wholesalers and exported to another European Economic Area (EEA) country, which can also affect supply. It's thought this may have become more attractive due to the drop in value of the pound.
  • Brexit In a similar way to the COVID-19 impact, this may also have been a factor insofar as contingency planning and uncertainty about supplies could have exacerbated the situation.

The government has now banned parallel exports of some medicines which were experiencing shortages - including paracetamol, HRT treatments, some vaccines and adrenaline - in an attempt to make sure there's enough for patients in the UK.

Finding alternative medication

Pharmacists and GPs are constantly working to find substitutes for unavailable medicines.

Sometimes a medicine unavailable at one pharmacist will be stocked elsewhere or can be ordered in.

If your medicine is in low supply the pharmacist might dispense the prescription in stages - giving you some upfront and asking you to come back at a later date for the rest.

But a lot of the time, patients aren't so lucky. One in five people we surveyed who faced a shortage had to take a break from their medicine until stock returned. One in four had substitute medication prescribed.

Getting used to a different formulation can create problems. One patient told us their substitute medication 'had nasty side effects and caused more problems than it solved'.

What can patients do?

With the continuing spread of COVID-19 and global uncertainty, it's now more important than ever to be responsible when buying medicine and only buy what you need.

That said, it's worth anticipating when you might run out and ordering new supplies before this happens.

The PSNC advises patients to order any medicines that you need from your GP in good time (but no more than seven days before it's due).

It also issued a reminder to only order medicines that you need. If you have unused medicines in your cupboard, use these first (remember to check the expiry date) and do not order extra medicines.

If you're experiencing issues with any substitute medication you are prescribed, talk to your pharmacist.