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Susanne Krejsa MacManus' five finger excercise

8/2020: The Third Man was almost upon us

Glas window in honour of Sir Alexander Fleming, Church of St. James, Sussex Gardens, Paddington, London

At almost the same time as the current coronavirus pandemic struck, the struggle began for the continued existence of Europe’s only penicillin manufacturing facility, in Kundl/Tyrol. Closing this production plant would have made Austria and the whole world dependent on Chinese deliveries of the active ingredient, one of the world’s essential medicines according to the WHO.

Fortunately, an agreement was reached in July. Thanks to an injection of financing from the federal and state governments and a large investment by the manufacturer, Europe’s penicillin supply is secured for the next 10 years, thereby averting a situation similar to that which Austria and other countries experienced immediately after the Second World War.

Austria and other countries already experienced the situation once of being completely dependent on foreign penicillin supplies, namely immediately after the end of the Second World War. Discovered in 1928 and incorporated into therapy in 1941, the antibiotic could only be produced (in relevant quantities) by Great Britain and the United States of America. Both countries furnished their troops with it; due to its importance for the war, the publication of all information relating to the selection of suitable culture strains, production conditions and medical application was blocked from 1943. But Nazi Germany was in any case only moderately interested, and had, in turn, cut itself off from scientific information from abroad, for example, banning the journal Nature from November 1937 onwards. Instead of (English) penicillin, it relied on (German) sulphonamides.

It was only at the end of 1943 that interest in penicillin took hold in Germany, but it was not possible to catch up with the head start of Great Britain and the USA. Then the war was over, and penicillin was sorely needed, but penicillin production could not be conjured up out of thin air: both the knowledge and the materials were lacking. It was no better in liberated Austria: due to our political dependence on Germany, our small geographical size and our lack of pharmaceutical infrastructure, no domestic development was possible in Austria either.

First delivery of penicillin by UNRRA arrives at Vienna on May 18, 1946. Source: Austrian National Library Picture Archives US 2135b

Until its own production started up, Germany got by, at least in part, with recovering penicillin from the urine of Allied patients who were being treated for sexually transmitted diseases.

From May of 1946, Austria received small amounts of the antibiotic from the United Nations Relief and Rehabilitation Administration (UNRRA): “The first quota of penicillin, worth $ 40,000, has arrived in Vienna. Since this delivery is only sufficient to treat roughly 20 cases a day for the next 6 months, it cannot be made available to general practitioners, but will be administered by specialists in specific clinics in Vienna and the provincial capitals.” Indeed, meticulous records had to be kept of every single penicillin patient.

The training for the Austrian medical professionals in the correct use of the active ingredient was carried out predominantly by British scientists, organised by the British Council. It was not until 1949 that Austria was able to cover its penicillin requirements by means of its own production.

As can be seen in Graham Greene’s film “The Third Man”, an existential shortage in a vital active ingredient leads to upheavals in civil society, which, in turn, endanger health: theft, counterfeiting and adulteration, smuggling, privileging affluent patients instead of applying criteria of emergency medical care.

The cases of fraud that emerged in connection with the current pandemic involving improper/substandard masks and protective clothing demonstrate at first hand the health and social risks entailed in outsourcing essential production from Austria/the EU/Europe.

My previous ‘five finger exercises’ and newsletters can be read here. I’d be delighted if they were shared!

I post my five finger exercises every so often, whenever I have something to relate.
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