At Xellia, we work at the center of this challenge every day. Here is our perspective on what is at risk, why it matters, and what needs to change.

The structural vulnerability in antibiotic supply chains

Over the past two decades, the production of active pharmaceutical ingredients (APIs) - the chemical building blocks of antibiotics - has shifted dramatically away from Europe. Today, an estimated 80% of APIs used in Europe are imported [1], with China and India together accounting for the majority of global antibiotic API manufacturing [2].

When production is concentrated in a small number of geographic regions, the supply chain becomes fragile. Geopolitical disruptions, logistical delays, or regulatory changes in exporting countries can quickly translate into medicine shortages. This is not a theoretical risk: antibiotic shortages have become more frequent in recent years, as an example: 19 countries in the European Economic Area experienced shortages of winter antibiotics in January 2024 [3] alone.

The disappearing European manufacturing footprint

Maintaining antibiotic production in Europe has become increasingly difficult. Many essential antibiotics are off-patent medicines, subject to intense price pressure in procurement markets, while production costs - including energy, raw materials, and regulatory compliance - continue to rise [4].

This economic imbalance has led to a steady erosion of European manufacturing capacity [5]. When manufacturers cannot sustain viable margins, they exit the market. And once specialised manufacturing infrastructure and expertise are lost, rebuilding them takes years.

Xellia continues to produce critical anti-infectives in Europe. Our facilities represent more than production sites: they hold deep technical expertise, apply rigorous quality standards, and provide a level of supply security that healthcare systems depend on. We are committed to sustaining this capability, but we cannot do it in isolation.

AMR raises the stakes

Antimicrobial resistance (AMR) is compounding the challenge. As more bacterial infections become resistant to existing antibiotics, the effective treatment options narrow. This makes the antibiotics that do remain effective more important than ever - and the consequences of supply disruption more severe.

At the same time, responsible use of antibiotics is essential to slow resistance. Today's procurement and pricing models often do not support this balance: they reward low cost over supply security [6], and volume over value. Reforming these incentives is critical to protecting both access and long-term effectiveness.

A shared responsibility

For decades, Xellia's has been a reliable partner to global healthcare and delivering life-saving medicines to patients worldwide. To ensure reliability, continuously investing in and maintaining a diversified manufacturing footprint is necessary, because the alternative is dependence on supply chains we do not control.

Securing resilient antibiotic supply chains is not a distant policy question. It is an immediate, ongoing challenge. Meeting it requires coordination across industry, healthcare procurement, and policymakers - with a shared understanding that resilience has a cost, and that cost is worth paying.

[1] EU Council's Critical Medicines Act documentation. → https://www.euronews.com/health/2025/11/26/europe-shows-no-signs-of-antibiotic-shortages-this-winter-eu-medicines-agency-says → https://www.consilium.europa.eu/en/policies/critical-medicines-act/

[2] https://www.nature.com/articles/s44259-024-00061-4

[3] European Medicines Agency (EMA), as reported by Euronews (November 2025). → https://www.euronews.com/health/2025/11/26/europe-shows-no-signs-of-antibiotic-shortages-this-winter-eu-medicines-agency-says

[4] New Angle independent study (2025) https://www.prnewswire.com/news-releases/european-study-shows-falling-prices-rising-costs-and-shortages-302619138.html & https://themedicinemaker.com/issues/2025/articles/october/securing-europe-s-antibiotic-supply-a-more-functional-future/

[5] Health Care Without Harm — Europe https://europe.noharm.org/news/can-eu-have-sustainable-antibiotic-supply-chain

[6] New Angle / Medicines for Europe study (November 2025) https://www.prnewswire.com/news-releases/european-study-shows-falling-prices-rising-costs-and-shortages-302619138.html

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Xellia is a specialised pharmaceutical company focused on the development and production of last-line-of-defence anti-infective medicines. We manufacture critical antibiotics in Europe and Asia and are committed to the long-term security of essential medicine supply.

Sources retrieved 25/03/2026