Access to necessary medicines is not always guaranteed in Italy
Over 2500 necessary medicines are not available in Italy, according to the list, constantly updated, of the Italian Medicines Agency (Aifa), a public institution that works under the direction of the Ministry of Health.
Mitomycin, for instance, is an antibiotic used to treat cancer in order to prevent the relapse of some types of tumour: in the summer 2019, it was impossible to find it in the whole country due to some production problems of the firm who owns the patent, until the Italian Medicines Agency (Aifa) authorised hospitals to buy the product abroad, at a higher price.
One of the reasons why some medicines are not available in Italy is the so-called “parallel market”, a legal phenomenon that exploits the differences in price between the individual European States: the existence of various prices in the different Countries can drive pharmaceutical industries to profit from the differences. A firm can buy a medicine produced in Italy, where it costs less, and resell it in a country whose health system is willing to pay a higher price, like the United Kingdom; moreover, when a medicine is marketed, it is not always distributed by the same firm that produces it: the producers often rely on wholesalers, who can sell it to anyone.
A 2018 survey by the European Association of Hospital Pharmacists (Eahp) confirms that in most cases the shortage of medicines causes delays in treatments, and sometimes even their suspension. When certain drugs are not available, the generic ones can usually be used. The lack of brand-name medicines, though, can destabilize the patient, and the effects of other drugs are not always equally satisfying.
The reasons why a firm can stop producing a certain medicine, or it can produce it with delays in the delivery, are several – production, for instance, may end because it is no longer economically advantageous. The medicine market is peculiar, with a complex balance: from 2014, the 90 per cent of the branch is owned by ten multinational corporations; the production sites are then relocated mainly to Europe (France, Italy, and Switzerland above all) and the United States, even though the most recent tendency is to relocate to Asia, saving on the labour costs.
The burst of the pandemic has newly exposed the necessity of a shared strategy at the European level; the sudden, rising demand for drugs for patients in intensive care units has laid bare the critical issues of the sector in Europe: together with the parallel market and the production problems, a dangerous dependence on China and India for the supply of generic drugs and the processing of active substances has emerged. Up until now, the European Union has mostly tried to prevent the shortage of drugs, encouraging the exchange of information between the various Countries, and between the latter and the firms, taking note of the market distortions but without, de facto, solving them.