Estonian medication stocks not adequate for healthcare crisis

Medications. Source: Siim Lõvi /ERR

There are insufficient quantities of antibiotics and over-the-counter medications available for Estonians to cover a crisis situation. While healthcare service providers maintain operating stocks, the quantities are neither checked nor regulated by the state. The Ministry of Social Affairs hopes that from next year, however, that situation will improve.

The exact quantity of the medication stocks is unknown. Head of the healthcare system development department at the social affairs ministry Agris Koppel told ERR that there are assessments ongoing regarding Estonia's needs.

"These also stem from a conflict situation assessment on how many casualties there may be at once who need to be treated or need surgery. And it could be said that as of today, we are not ready to that extent," Koppel said.

Today's medication market can be divided into two. The first and bigger part is the operating stocks of health care service providers. The stockpiling of them is the responsibility of hospitals and the ambulance.

"And it has been an agreement or according to the health care provider's own discretion or ability, depending on the volume of its service provision," Koppel said.

A couple of years ago, the situation was much clearer, at least on paper. According to the government's regulation, the ambulance brigade operators needed to be stocked for at least five days and hospitals for two months. In reality, the two-month requirement has never been checked.

"During peacetime, every cent spent on stocks seems to be if not a waste then at least impractical," Koppel went on.

The required regulation hasn't been in the law for years

Service providers were spared the fear of being checked up on in 2017 when legislative amendments entered into force, making the previous regulation no longer valid. The new law, which has been valid for over four years, states that the minister sets the rules for operating stocks. There is no such regulation in place, however.

Koppel remembered that after the law amendment, the topic was discussed for over a year and a half and it was then decided that the number of stocks and their composition need to be further analyzed.

"And the Health Board (Terviseamet) went to look for that analysis from experts and the first procurement wasn't successful. In 2019, the University of Tartu Clinic's expert group started the analysis. The hope was that by the start of 2020 at the latest, the analysis would be ready and it would possible to start establishing the new order based on that," Koppel said.

Then covid arrived, and the whole vision of preparing for health care crises changed. Koppel hopes that the regulation will be announced in the first quarter of next year.

In addition to the service provider operating stocks, the new regulation will also regulate the requirements for state health care stocks. These are currently stored in the University of Tartu's Clinic, and the Health Board is responsible for them. They are intended for crises where a lot of people need medical aid at the same time.

"It's clear that the stocks need to be bigger. The size of the stocks stemmed from the Health Board's budget limits. Around half a million euros has been spent every year on preserving these stocks, but the necessity is greater than that," he added.

Koppel believes that next year, the situation will improve. Medication stocks will be finally regulated.

Medicines may also run out in pharmacies

Last summer, the social affairs ministry started looking for a solution to another problem. While ambulances and hospitals have at least some stocks, this isn't matched in pharmacies serving the public.

If Estonia gets hit by a crisis that puts the supply of medications completely on hold, pain killers, asthma medications, many antibiotics and over-the-counter and prescription medications are likely to run out in an as-yet unspecified time. This in turn adds to the burden on hospitals.

"I think two years ago, when some of our experts even tried to say that when war comes and when borders close, that's what happens. But during peacetime, it's very difficult to communicate and explain that this can happen," Koppel said.

Negotiations with wholesalers have been going on for more than a year now. The planned stock of medications for the population would not be bought out by the state until it is really needed. It is planned to compensate wholesalers to keep larger quantities in their warehouses.

"We started with a very long period and such a 2-4 month scheme when talking to wholesalers. And we haven't really buried the idea and it's really about compensation mechanisms," Koppel said. In other words, how many wholesalers want money to preserve the stocks and how much the state is willing to pay for it.

Koppel added that the Estonian Stockpile Center could start managing the stock of medications intended for the population.

"We have an organization that is gaining more and more competence in valuing, storing, rotating inventories, coping with all these difficulties," Koppel said.

When and where an agreement will be reached with wholesalers is currently unknown.


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Editor: Roberta Vaino

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