The World’s Penicillin Problem was a series of stories published in five continents about the reasons underlying a global penicillin shortage, which has affected over 40 countries in the last two years, from the US and India to Portugal and France. The project was possible after the reporter secured a 20,000 euros grant from the European Journalism Centre, and the resulting investigation was published with Quartz, Al Jazeera, Folha de São Paulo, El Mundo, Mail & Guardian and The International Business Times UK.
This data-led, cross-border investigation mapped the supply chain of penicillin by combining various data sources, revealing how companies kept production of this cheap medicine at low levels because it wasn’t profitable, causing shortages across several countries. Through data scraping and data analysis, interviews with top global experts and exhaustive sourcing, it uncovered that the world today relies on four single companies – three of them located in China – for the global supply of injectable penicillin, after dozens of companies left the antibiotic market in the last decade looking for higher margins.
The story also looked into the patients who need this life-saving drug and into how shortages of crucial antibiotics such as penicillin fuel the risk of antibiotic resistance in old, but deadly diseases. This provided a human face to the data, enabling the story to be more personal and therefore more powerful.
The primary aim of the project was to raise awareness of the human cost of running out of an essential medicine such as penicillin, the world’s oldest antibiotic. The second goal was to help policymakers understand the current limitations of the pharmaceutical industry to serve the global need of a product where few, if any, alternatives are available. The third goal was to spark a debate around the roles of government, industry and regulatory bodies in addressing the issue.
These were successfully achieved with the six stories published worldwide: the data- and human-led investigation was a real scoop, being shared thousands of times on social media by readers and experts, generating relevant discussions on the right of all to access essential medicines; congressmen in Brazil inquired the country’s Ministry of Health about the shortage and exemptions to penicillin manufacturers banned for quality issues; the journal Plos Medicine invited the author – Keila Guimaraes – to review the first paper-ever on penicillin shortages, backed by the World Health Organization, and featured exclusive information revealed by the investigation.
Although it combined epidemiological data, recent scientific discoveries on antimicrobial resistance and delved into the business dynamics of the pharmaceutical industry, the stories were written in clear language with the aim to engage the general audience and to bring the general reader closer to the the topic.
What makes this project innovative?
The combination of human voices from patients and doctors from various countries intertwined with a vast number of global data sources on the penicillin market and the diseases that are only curable with this drug was a unique approach to the issue of drug shortages, usually reported as a isolated problem instead of a cross-border challenge.
Global data on diseases' incidence from sources such as the WHO Health Estimates and the Global Burden of Disease, and figures on global drug manufacturers from EudraGMDP and UN Comtrade were essential to draw a picture of the number of those in need of penicillin and of the global trade of this drug.
The innovative data analysis were presented as maps and graphics to improve readers' understanding of how many people were affected by shortages of this essential antibiotic and for tracing a clear path of the global supply chain of penicillin. For example, a small multiple map was used to present in depth how dramatic the current maternal and congenital syphilis outbreak in Brazil. It brought to light 15 years of data on these infections across the country, revealing how shortages of this drug during the outbreak was related to the death of hundreds of newborns in the last few years.
These visualizations also revealed how poor regions around the world, notably sub-saharan Africa and Asian countries, suffer the most with rheumatic heart disease (RHD), an illness related to a high rate of maternal deaths. Both diseases, syphilis and RHD, can only be addressed with injectable penicillin.
What was the impact of your project? How did you measure it?
He also took the topic to be discussed at a TV programme by Brazil's Senate, further spreading awareness about the issue of penicillin shortage and about the stories. In July 2017, he requested a public meeting to be held by the the Human Rights Commission in Brazil's Senate to discuss the shortage of penicillin, which affected the country between 2014 and 2017.
In August 2017, US Congresswoman Debbie Wasserman Schultz sent a letter to the US Food & Drug Administration to call on the agency to address the Penicillin G benzathine shortages in the US, two months after the stories were released in the country. The US has seen a two-year long shortage of penicillin, which is still affecting the country up to today.
On top of being released in six countries in five continents, it was picked up by news companies in Brazil, South Africa, US and others, being featured in Modern Medicine, Risk Africa Magazine and Canadian Drug Shortage, ensuring a global impact to the pieces on penicillin shortages.
Brazil's digital paper Nexo did a full story on the investigation's main findings while Volt Data Lab, a data-driven journalism agency in Brazil, published a piece using the data collected by the projects' team. Jeremy-Singer, Buzzfeed US data editor, shared the penicillin stories as a top piece on his Data is Plural newsletter, after being provided by the author with the different data sources used for the project.
These are examples of how the data community in different countries engaged with the stories, further spreading the word about useful sources to report on drug shortages, diseases' incidence and antimicrobial resistance, so other journalists could pursue these topics.
Source and methodology
For finding out the penicillin manufacturers, my main source were drug agencies' records. Listed here are the ones monitored on a regular basis: European Medicine's Agency, China's CFDA, India's CDSCO, UK's MHRA, France's ANSM, Portugal's Infarmed, US's FDA, Australia's TGA and Brazil's Anvisa.
EudraGMDP, a database maintained by the European Medicines Agency, was also crucial for finding records of suppliers and reports of non-compliant drug companies. In these records it was possible to obtain names and addresses of factories, substances produced in those plants and sometimes the countries buying those pharmaceutical ingredients.
As the World Health Organization wouldn't disclose the names of the four single companies that today are responsible for the global penicillin supply, the records from the sources listed above were crucial to map out the manufacturers. Once I had a list of possible producers, with names and addresses, the WHO confirmed those were the correct producers.
Another line of inquiry was the impact of shortages on patients worldwide. For quantifying that, we looked into the number of people suffering from diseases only curable with penicillin up to this day, 73 days after this drug went commercial. For that, the WHO Global Health Estimates and the Global Burden of Disease were essential to find statistics broke down by country on illnesses today mostly forgotten. Interviews with case studies from various countries brought a human face to the figures.
Insights into drug trade was possible with data from the UN Comtrade, which has estimates for imports and exports of active pharmaceutical ingredients. With that it was possible to illustrate the flow of medicines from China into powerful drug markets, such as the US and India. Finally, with QuintilesIMS reports it was possible to grasp the shift from antibiotics to more expensive medicines in the pharmaceutical industry.
It became necessary to scrape many PDFs for the project, especially from EudraGMDP, the European database of manufacturers and compliance reports. The data gathered through these tools was then analysed in Google Sheets and Excel, depending on the size of the datasets.
Google Drive was the main hub for collaboration, as various professionals were involved at some point of the work: an extra data journalist (mentioned below), plus social media producers to help with awareness campaigns for the stories.
As the six editors publishing the stories were spread across several countries (US, UK, South Africa, Spain, Qatar and Brazil), it was crucial to have the stories, photos and graphics all stored in a cloud service easily accessible to everyone.
Data visualization was done with various tools: charts were plotted in R using the library ggplot. Geographical data was visualized with QGIS, then further styled in Adobe Illustrator.
All original files were given to the newsrooms publishing the stories in .ai format, so each publisher could style the graphics with their proprietary fonts and colours.