The way out of the pandemic — it will only open up when as many people as possible have been vaccinated. Until then, however, medicine is relying on generic products: the first aid kit used to treat COVID-19 patients in intensive care units consists almost exclusively them.
The COVID 19 pandemic continues to have Germany firmly in its grip. Although more and more vaccines are being approved and are fuelling hopes for an end to the pandemic. At the same time, however, thousands of infected patients are in intensive care units. Here, doctors and nurses are fighting for the lives of the patients. Mainly with generic medicines.
Hardly any medicine helps against COVID-19
There is still hardly any effective medicine against the virus. The hope that individual pharmaceuticals generated at the beginning of the pandemic has largely disappeared again. Agents such as the initially promising hydroxychloroquine are — according to the official S2k guideline, which gives recommendations for the inpatient therapy of COVID-19 patients — no longer recommended for use in COVID-19.
Even Remdesivir, for a long time the promising drug of choice, no longer has a clear recommendation from the World Health Organisation (WHO). Only a therapy with dexamethasone — a well-known generic medicines — should be used for “patients with severe or critical COVID-19 disease” according to the guideline.
Generics are used for the most part in intensive care units
The intensive care staff in the hospitals therefore do everything they can to ensure that the patients’ own body defences can defeat the virus. Their treatment is primarily aimed at keeping the bodies of the seriously ill patients alive. In doing so, the doctors mainly resort to tried-and-tested medicines — active substances, in other words, that are almost exclusively off-patent.
The “first aid kit” used in intensive care units for Covid 19 patients contains almost exclusively generic medicines. This is shown by two lists compiled by the Federal Institute for Drugs and Medical Devices (BfArM) at the beginning of the pandemic. They contained all preparations whose demand, according to experts’ estimates, could increase by 300 percent and 200 percent, respectively, in the months of the first wave due to the pandemic.
First of all, it deals with so-called analgesics. These analgesics (e.g. sufentanil, morphine sulphate, novamine sulphone) are all produced generically. So-called relaxants — these are drugs that may be needed during ventilation — are also generically available active substances. The same applies to anti-obstructive drugs.
The administration of oxygen is central to the treatment of COVID patients. It can be administered via a nasal tube, mask or nasal cannula (high-flow therapy). If the patient’s condition deteriorates, invasive ventilation may also be necessary. This is done by means of a ventilation tube that can only be placed in the trachea under anaesthesia. And the anaesthetics (or also: sedatives) that are indispensable for this are also produced generically.
Generic companies produce far more than the usual amount of active ingredients needed
Especially the active ingredients propofol and midazolam, which are crucial for anaesthetists in this situation, were in danger of becoming scarce at the beginning of the pandemic in spring 2020. The reason for this was the sharp increase in demand, which was also due to the fact that the hospitals were preparing for the expected rush to the intensive care units.
In an unprecedented show of strength, generic drug manufacturers ramped up their production, rededicated production lines and searched for alternative suppliers all over the world. In the meantime, they have adapted production to the increased demand. And this applies not only to the drug manufacturers, but also to the suppliers who provide active ingredients, closures or packaging. These are all things without which a medicine cannot be produced and which have to cope with exactly the same increase in demand in times of crisis.
Of the 71 agents that a ventilator patient potentially needs, 69 are generic
In addition, there are other active substances — such as antibiotics, blood pressure medication or cardiac preparations — which intensive care physicians use due to various symptoms or pre-existing conditions. In total, the BfArM’s list, which contains all the active substances in intensive care medicine that are relevant for COVID-19 patients and may be in short supply, contains 71 medicines. And 69 of these are generic.
Vaccines mark the way out of the crisis — generics save lives for so long
The story of the fight against the pandemic — it cannot be told without generics. Because the COVID-19 patients who leave the intensive care units of our hospitals cured owe it largely to generics. In other words, the drugs that make up the vast majority of medicines. Not only, but also in the greatest health crisis of our time.