Part 2: The parallel case for medicines - A Jesuit perspective for the EU
In the spirit of thoughtful discernment and the pursuit of the common good - a hallmark of the Jesuit tradition—we must examine, with both rigor and compassion, the complexity of parallel trade within the European Union (EU). At its core, parallel trade capitalizes on price disparities among member states: medicines are purchased in nations where they are cheaper and then resold in higher-priced markets. Although this aligns with the free movement of goods enshrined in the EU’s single market philosophy, we must ask whether this practice inadvertently jeopardizes the stable supply of essential medicines. In doing so, we may realize that what appears to be an economic convenience for some can evolve into a healthcare challenge for many.
“No one is useless in this world who lightens the burden of another.” – Charles Dickens
The moral imprint of pricing disparities
Pharmaceutical pricing in the EU follows multiple pathways, reflecting national legislation, economic contexts, and distinct healthcare priorities. In some instances, governments adopt external reference pricing (ERP)—setting drug prices by referencing a basket of peer countries—while others use internal reference pricing, aligning therapeutically similar treatments within their healthcare systems (European Parliament, 2021). These varied approaches create significant cost differences for the same medicine across member states.
In theory, parallel trade could help patients in higher-priced markets gain access to more affordable drugs. Yet the benefits for one group can quickly translate into burdens for another. Pharmaceutical companies typically allocate stock based on the consumption needs of their local market; when parallel traders purchase large volumes to export, the original forecasts are upended, risking shortages in the exporting country (EFPIA, 2019). This imbalance highlights the ethical quandary: ensuring some patients pay less might unintentionally deprive others of critical treatments—an outcome that undermines the broader spirit of solidarity.
“To put everything in balance is good, to put everything in harmony is better.” – Victor Hugo
Fragile supply chains and the call for prudence
Contemporary pharmaceutical supply chains are profoundly intricate. A substantial share of active pharmaceutical ingredients (APIs) is manufactured outside Europe, predominantly in Asia, which lengthens lead times and introduces global vulnerabilities (European Commission, 2020). Parallel trade adds to these vulnerabilities by causing unplanned shifts in demand: essential medicines such as amoxicillin or piperacillin-tazobactam may be diverted from lower-priced to higher-priced markets, leaving exporting countries suddenly short (World Health Organization, 2022). In recent years, intravenous immunoglobulins (IVIG) and certain oncology drugs (e.g., cisplatin, methotrexate) have also been reported in shortage across multiple EU member states, with parallel trade compounding the strain on already limited supplies (European Medicines Agency, 2021).
From a Jesuit vantage point, prudence demands we weigh immediate economic gain against the well-being of entire populations. Healthy, resilient supply chains are paramount for patient care, cautioning that persistent redirection of stock can amplify shortages and push healthcare systems to rely on less effective or more expensive substitutes. Such disruption can further accelerate antimicrobial resistance—an issue that reverberates far beyond any single nation’s borders.
Economic and human consequences
Advocates of parallel trade often tout the benefits of increased competition, particularly for countries with higher drug prices. While parallel imports may reduce costs in those markets, actual savings can be undercut by administrative and regulatory expenses linked to repackaging and re-importation. Moreover, some manufacturers compensate for revenue losses in lower-priced regions by elevating overall pricing, undermining the intended effect of cost containment (EFPIA, 2019).
The repercussions, however, are not merely financial. Patients deprived of timely access to first-line therapies must rely on second-line or less effective treatments, potentially leading to poorer clinical outcomes and heightened healthcare costs. In the face of global drug-resistant infections, any threat to the availability of critical antibiotics - and indeed other pivotal medications—imperils public health. Such vulnerabilities highlight the moral imperative to weigh profit-driven incentives against the fundamental aim of protecting human lives, especially those of society’s most vulnerable.
Policy struggles and the call to community
EU policymakers are challenged to uphold the single market’s principle of free circulation of goods while guaranteeing the availability of essential medicines. Parallel trade restrictions can appear incompatible with the EU’s foundational liberties (European Commission, 2020). Additionally, national autonomy over drug pricing leads to diverse and sometimes conflicting strategies, rendering complete harmonization elusive (Council of the European Union, 2021).
The European Commission’s Pharmaceutical Strategy for Europe aims to fortify supply chain resilience through diversification and greater transparency. While these proposals carry significant promise, they risk being thwarted if parallel trade continues siphoning critical stock from lower-priced countries. The pursuit of immediate profits must not overshadow the collective ethical obligation to safeguard public health.
A Common Roster for Common Solutions: The EMA’s Critical Medicines List
Alongside these policy measures, another vital element has emerged in the quest for equitable drug distribution: a Critical Medicines List maintained by the European Medicines Agency (EMA). Under Regulation (EU) 2022/123, the EMA’s mandate has been expanded to bolster monitoring, coordination, and crisis response for medicines that are essential in managing major public health events (European Medicines Agency, 2023). This approach exemplifies Ignatian reflection in practice - fostering a collective recognition that safeguarding the common good hinges on transparent, real-time data sharing across the EU.
By identifying and regularly updating this list of critical medicines, including those at risk of shortage, the EMA and national regulators can act swiftly before minor imbalances spiral into emergencies. Parallel trade’s impact can also be closely monitored - particularly in the case of oncology drugs, advanced therapeutics, or life-saving antimicrobials that appear on the list. Through this expanded framework, national health authorities align contingency plans, share best practices, and reinforce the Jesuit principle of cura personalis - care for the whole person- ensuring that no patient is left unprotected because of market-driven distortions.
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Pathways of hope: pragmatic and just policy ideas
A Jesuit approach to policymaking integrates justice and solidarity with practical solutions. The following measures, adapted from existing proposals, reflect this balanced perspective:
Concluding with Discernment and Hope
Rooted in the Jesuit tradition, our analysis goes beyond purely economic calculations to embrace a vision of shared humanity. Parallel trade may present temporary benefits for some European countries, but it also amplifies the risk of shortages in others. Recognizing these trade-offs and striving for policy solutions that protect all patients - especially the most vulnerable—honors the deepest values of compassion, solidarity, and responsibility.
By aligning economic freedoms with the principle of safeguarding life, policymakers, stakeholders, and citizens can foster a healthcare landscape that avoids exploitation and promotes health equity. True progress emerges when free movement does not translate into free-for-all shortages but instead upholds the cornerstone of community care. If we remain guided by the conviction that every life deserves dignity and reliable access to essential medicines, we can—in the words of J.R.R. Tolkien—help even “the smallest person” shape a more hopeful future.
References:
Council of the European Union. (2021). Council conclusions on strengthening the balance in the pharmaceutical systems in the EU and its Member States. Brussels: Council of the European Union.
European Commission. (2020). Pharmaceutical Strategy for Europe. Brussels: European Commission.
European Commission. (2021). Joint procurement framework contracts: Lessons from COVID-19. Brussels: European Commission.
European Federation of Pharmaceutical Industries and Associations (EFPIA). (2019). Parallel trade in Europe: Impact on patients and innovation. Brussels: EFPIA.
European Medicines Agency. (2021). Shortages of medicines: A growing EU challenge. Amsterdam: EMA.
European Medicines Agency. (2023). Human medicines shortages. Retrieved from https://www.ema.europa.eu/en/human-regulatory/post-authorisation/shortages/human-medicines-shortages
European Parliament. (2021). Study on shortages of medicines—how parallel trade and pricing policies influence availability. Luxembourg: Publications Office of the European Union.
French Ministry of Health. (2021). Plan national de gestion des pénuries de médicaments. Paris: Ministère des Solidarités et de la Santé.
Medicines for Europe. (2023). Securing Europe’s medicines supply: Challenges and priorities. Brussels: Medicines for Europe.
World Health Organization. (2022). Addressing the global shortage of medicines and vaccines. Geneva: WHO.