There is a serious shortage in Japan of medicine such as cough suppressants and expectorants, with no hopes of the situation improving anytime soon.

To ensure a stable supply, the central government has requested pharmaceutical companies increase production and has offered financial support, but due to the structural problems the industry is facing, there is no prospect of the shortages being resolved.

PROBLEM SPREADING

“Cough remedies and expectorants have been out of stock for nearly six months,” said Hiroya Iijima, a pharmacist at a drug store in Ueda, Nagano Prefecture.

When the store askes the wholesaler when it can expect to receive another shipment, it only receives a reply of, “I don't know,” Iijima said.

Iijima said when the store does not have the prescribed medications on hand, he asks the doctor if the prescription can be changed to a different medication.

The Ueda pharmaceutical association visualizes the entire inventory of prescription medication about 50 pharmacies that have agreed to the program, and if there is a shortage of one medication, the pharmacies share their inventory.

However, there are times when other pharmacies do not have them, meaning doctors are unable to prescribe them.

“Antibiotics, diabetes medications and drugs for high blood pressure are also becoming difficult to obtain,” Iijima said. “Instead of the medicine shortage being resolved, it’s only spreading.”

There is a growing sense of concern in the medical field.

In early November, the Japanese Medical and Dental Practitioners for the Improvement of Medical Care (Hodanren) held a news conference in which doctors said that “changes in prescriptions are endangering the health of patients.”

Due to the lack of inventory, practitioners sometimes ask patients to buy over-the-counter medication, or they dilute adult pills and prescribe them to children.

An association of practitioners in Okayama Prefecture conducted a survey, and of the 180 medical facilities that responded, 87.8 percent indicated they had difficulty obtaining some medications.

In addition to cough medication and expectorants, there were shortages of medicines such as antipyretics, antibiotics, diabetes medications and antidepressants, the survey found.

As of the end of October, 10.1 percent of all drugs (14.1 percent for generics) and 13.5 percent (18.9 percent for generics) were in limited shipment, according to a survey conducted by the Federation of Pharmaceutical Manufacturers’ Associations of Japan.

PANDEMIC ROOT CAUSE

The supply shortage began with a series of administrative actions against generic drug companies in 2021.

More than 10 companies, including industry giants, were found to have committed quality fraud, including the adulteration of sleep-inducing drugs and fabrication of test results, resulting in the suspension of business operations.

When one item is suspended, another company responds by increasing production or stocking up on the medication that is in short supply.

However, because drugs are systematically manufactured while forecasting demand, it is not possible for a company to immediately switch production to a different drug.

The current drug shortage is also largely due to the COVID-19 pandemic.

In 2020 and 2021, the number of patients with non-coronavirus infections eased from normal years as many people took precautions against infections and refrained from going out. Shipments of cough suppressants were also about half of those in previous years.

However, since May of this year, when COVID-19 became a category 5 under the infectious disease prevention law, various infectious diseases such as respiratory syncytial virus (RSC) and influenza have begun to spread more.

In September, the health ministry notified medical institutions and pharmacies to minimize prescriptions of cough medicine and other drugs. However, the situation did not improve, and in October and November, the ministry twice asked pharmaceutical companies to increase production.

By the end of the year, the supply of cough suppressants and expectorants is expected to increase by more than 10 percent compared to the end of September.

In addition, measures to support the expansion of facilities for increased production and the securing of personnel were included in the central government’s comprehensive economic stimulus package approved by the Cabinet in November.

However, structural problems in the industry remain. To reduce medical costs, the government has been promoting the switch to generics, and the percentage of generic drugs has increased from 36 percent in 2009 to more than 80 percent in 2023.

On the other hand, each time drug prices are revised, prices fall, and companies are faced with an increasing number of unprofitable products. Many of the drugs in short supply are low-priced generic drugs, and even if production is increased, it would be difficult for the firms making them to generate profits.

In response to such issues, the ministry’s study group has proposed better visualizing the supply status of generic drugs and giving preferential treatment to companies that provide stable shipments under the drug price system.

(This article was written by Kazuhiro Fujitani and Kazuya Goto.)