Now not only fever juices are scarce - with parents and paediatricians the concern is growing

“Fever syrup for children?” The pharmacist in Wiesbaden regretfully says no. “And before you ask: Unfortunately, we no longer have fever melt tablets.” The display for the painkillers in the ordering system is deep red, and there is no information about when the drug will be available again. "The Fever Juice sometimes has something available. If that happens, you have to be quick,” says the pharmacist, who wishes to remain anonymous. "If I wanted to order something today, I would get nothing."

Anyone trying to get fever medication for their sick toddler these days has a problem: juices with the active ingredients ibuprofen or paracetamol are only available sporadically, not only in Wiesbaden, but nationwide. You have to be lucky that the pharmacy in question just happens to have the medicine in stock. Apparently, it is currently not possible to order child-friendly orodispersible tablets with the active ingredient ibuprofen.

Only in the case of fever suppositories does the pharmacy’s ordering system report sufficient availability. But there is currently a significant lack of suitable dosage forms for antipyretics, especially for children who are out of baby age but cannot yet swallow tablets like adults.

The problem is not entirely new, it was already known in the summer that fever juices are scarce in Germany. But in the meantime, with the orodispersible tablets, the second dosage form is apparently also affected. Against the background of the flu season, which according to the Robert Koch Institute is currently gaining momentum, the shortage is having an even more serious effect than in the previous months.

Pediatrician Christian Neumann is correspondingly worried about the forthcoming wave of influenza. “The supply of antipyretics for children is already more than unsatisfactory. But for the time after Christmas, when the flu epidemic hits and the kids have a high fever for five days, I'm really worried."

The doctor and representative of the professional association of paediatricians in Rhineland-Palatinate has his practice in Zweibrücken. In emergencies, he now advises the parents of his patients to drive across the border to France - because care is not a problem there. "We have had an extreme shortage of various drugs in Germany for a long time, which has little to do with the real production capacities, but a lot to do with bureaucracy - nothing is being done about it politically."

In fact, there has been a shortage of medicines in Germany for years. Sometimes it hits a broad-spectrum antibiotic like Cotrim, sometimes even a drug that is as important as the cancer drug tamoxifen. According to the database of the Federal Office for Drugs and Medical Devices (BfArm), around 300 drugs are currently not available. Five years ago, the problem didn't affect half as many drugs.

There are many reasons why medicines are always scarce in a country as prosperous as Germany. One of them has to do with production in Asia, which has been significantly more prone to disruption than before in recent years due to the pandemic.

The much more important factor, however, concerns the price of so-called generic drugs, i.e. drugs that can be produced by any number of manufacturers after the original drug’s patent has expired. Because the reimbursement price of the health insurance companies for these drugs is often very low, the production does not pay off for many manufacturers.

As a result, they withdraw from the market until only one or two providers remain. If there are problems in production, the defect is almost inevitable.

Something similar happened with fever medication for children. In May of this year, the manufacturer 1A Pharma stopped producing paracetamol fever syrup, making the Israeli Teva group the main supplier and since then, according to the Pro Generika manufacturers' association, has had to supply over 90 percent of the German market.

The first bottleneck was quickly followed by the next, because this caused the demand for fever juices with the alternative active ingredient ibuprofen to increase rapidly. "In addition, there was a wave of colds in the summer - with the result that manufacturers of ibuprofen fever juice were faced with an eightfold increase in the number of orders," according to the manufacturers' association.

According to industry information, the manufacturer Zentiva, as the main supplier of ibuprofen fever syrup, has meanwhile cleared a complete production line just for this product. But obviously that's still far from enough to meet the nationwide demand that has increased significantly due to the loss of fever juices with the active ingredient paracetamol.

Such domino effects quickly cause supply to falter. And could possibly also be the reason why with the orodispersible tablets – which are not generic – the second dosage form for children is apparently also becoming increasingly scarce.

"Supply bottlenecks have long been an issue that doctors, pharmacies, pharmaceutical wholesalers and, last but not least, patients have had to deal with. Currently, it is indeed still the case that pharmaceutical wholesale companies cannot fully process orders for juices containing paracetamol or ibuprofen," confirms the pharmaceutical wholesale association (Phagro) of the fundamental shortage of fever juices for children.

"The reimbursement system of our healthcare system has a blind spot - and that affects children's medicines," criticizes Bork Bretthauer, Managing Director of Pro Generika. Since children received a smaller amount of active ingredient, children's medicines would be remunerated less. In addition, the different effort that arises in the manufacture of the different dosage forms is not taken into account: "Anyone who manufactures children's medicines will be punished by the system," he says. "The situation with pediatric drugs thus shows the problems of generics as if through a magnifying glass."

Pediatrician Neumann is still trying to remain capable of acting in the current situation. For real emergencies, the doctor has therefore stashed an emergency supply of doctor's samples in the medicine cabinet in his practice. "But even those supplies are running out," he says.

Especially since Neumann does not only name the antipyretics as a problem. Cough syrup, electrolyte solutions and certain antibiotics are also currently difficult to obtain: "I see an urgent need for political action here before it gets really scarce in winter."

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