Geopolitical instability in the Middle East has not, at this stage, produced systemic disruptions in the availability of medicines in Europe. However, it intersects with an economic and industrial structure that presents measurable vulnerabilities. The issue is the structural resilience of the supply chain in a global context that is likely to remain volatile.
Dependence on global intermediate inputs makes the system sensitive to fluctuations in energy costs and tensions along trade routes. Even a structural cost increase in the range of 5–10% can significantly affect the sustainability of low-margin production lines, particularly in the generics segment.
Healthcare represents one of Europe’s main macroeconomic aggregates. According to Eurostat, total healthcare expenditure in the European Union exceeds €1.7 trillion, equal to about 10% of European GDP. In OECD countries, healthcare spending averages between 9% and 10% of GDP. In Italy, public healthcare spending stands at around 6–7% of GDP, with a more moderate growth trend compared to other major European countries.
Within this aggregate, pharmaceutical spending plays a central role. In Italy, total pharmaceutical expenditure exceeds €37 billion, of which more than €26 billion is borne by the public sector. Medicines purchased directly by public healthcare facilities amount to more than €17 billion. Public pharmaceutical spending accounts for approximately 19–20% of total healthcare expenditure. This means that any tensions in the pharmaceutical supply chain extend beyond the sector itself, directly affecting regional budgets and the sustainability of the healthcare system.
One of the structural bottlenecks concerns active pharmaceutical ingredients (API). Between 60% and 70% of the APIs used in Europe are produced outside the European Union, predominantly in Asia. For certain mature therapeutic classes—antibiotics, cardiovascular drugs, analgesics—the share can exceed 70–80%. More than two-thirds of shortages recorded in Europe in recent years involve a small group of active ingredients found in numerous molecules, a sign of strong industrial concentration.
In a scenario of tension along trade routes, with possible increases in insurance premiums and transit time extensions of as much as 10–14 days, pressure would concentrate precisely on mature, low-margin molecules.
The Italian pharmaceutical industry represents one of the country’s main manufacturing sectors, with approximately €56 billion in annual production, more than 70,000 direct employees, and an export share exceeding 85% of output. The sector is highly competitive and integrated into global value chains.
Although a generalized systemic shock to medicine availability appears unlikely, the risk is one of gradual industrial selection: the withdrawal of economically marginal molecules, a reduction in the number of operators participating in tenders, greater market concentration, and lower resilience over the medium term.
