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Hospitals and pharmacies in many countries around the world report increasing difficulties, including interruptions, in the supply of medications. How do we explain this worrying phenomenon ? And how can we try to avoid stockouts and treatment disruption ? The main causes have been identified as the shortage of raw materials; the lower quality production of pharmaceutical drugs; a declining number of manufacturers which have to supply growing populations. Yet, one of the main reasons which explains the difficulties faced by health professionals and patients is the rapid pace of concentration of the pharmaceutical industry worldwide. Today 60% to 80% of active pharmaceutical ingredients come from outside the EU, and from Asia in particular , compared with barely 20% just 30 years ago. But it must be noted that a delocalised production does not necessarily imply that it would be of poor quality. Many industrial sites located in India or China are well equipped centres with modern and safe infrastructures that produce medicines of undeniable quality. Having said that, an extreme concentration of production plants in only a handful of countries is obviously not healthy. The risk is that these few companies will sell their products only to the countries willing to pay a premium in order to prevent stockouts of key pharmaceuticals. And we must sound the alarm when it comes to anticancer or anti-infectives treatments. Is it reasonable that a country like Switzerland which is home to some of the biggest pharmaceutical companies in the world may face supply problems with essential drugs ? But it is also true that some observers suggest that the primary cause of the shortage of drugs is economic. The industry would try to remove the older drugs which are at present available in a generic form in order to increase the sales volumes of their newer drugs that are much more profitable. And the intermediaries would hold significant levels of stocks in order to drive up prices. Countries affected by this phenomenon must build up emergency stocks. Obviously, the health of populations must be made a priority over the economy.

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