Rx Crisis: Battling Medicine Shortages

Access to medicines is a human right.

However, this right is put under pressure now the healthcare system faces significant challenges due to medicine shortages, affecting patients and healthcare professionals.

This edition of #ArarNotes presents solutions and consequences related to the issue of medicine shortages as a global challenge.

Definition of Medicine Shortages

It's defined as the short-term or long-term unavailability of essential pharmaceuticals, which can occur in various circumstances, impacting specific geographic areas and undermining the ability of the healthcare system to deliver optimal treatment.

Shortages of medicines can be short-term or long-term, and they are frequently caused by a variety of circumstances, including interruptions in the production process, regulatory problems, supply chain concerns, and market distortions.

Antimicrobial & cardiovascular agents continue to remain the areas that most frequently experience shortages.

A new approach to better tackle medicine shortages is needed.  

The objective is to have safe, effective & affordable medicines guaranteed for every citizen worldwide.

Overview of Medicine Shortages & its Consequences

To maintain the continuity of treatment and the well-being of the patients, it is crucial to address acute & chronic shortages. chronic shortages persist over an extended period, creating more severe implications for HC & patients.

This results in canceled or delayed treatments, higher costs for patients and healthcare systems, adverse effects that might even lead to death, and increased aggression against community pharmacies. HCPs must consider the financial & moral burden on HCSs, collaborate, and develop efficient strategies to lessen the effects of shortages.

In some instances, the lack of essential drugs can cause symptoms to worsen & illnesses to advance. The psychological impact should also be considered, as medicine changes induce stress and fear.

In times of drug shortages, community pharmacies, vital to providing medications, face unique difficulties; pharmacy management of the effects of shortages on patients requires navigating the supply chain complexity and confirming the impossibility of satisfying prescriptions.

Leading causes for Medicine Shortages

1. The production & supply of APIs

Around 60-80% of the products used in medicines are produced in China and India. In the COVID-19 pandemic, shortages of active pharmaceutical ingredients (APIs), excipients, and drugs occurred worldwide.

As a result, the countries (India, China, and the United States), the producers of APIs stopped supplying some APIs to other countries, which led to a global shortage of many drugs.

Moreover, many other challenges, including shortage of packing material, disrupted transport, delayed shipping, delayed customer clearance, and restricted import-export of APIs and drugs worldwide.

Currently, all countries aim to "move" production from Asian countries to their countries to facilitate the supply of medicines within their borders.

Those factors can be located at almost every level of the supply chain of medicines, ranging from the supply of crucial materials and energy to logistic operations. It can be safely presumed that the main driving forces behind those turbulences are the aftereffects of the COVID-19 pandemic, the military conflict, and inflation.

Of course, at this particular time, with inflation soaring and the energy crisis exponentially increasing the cost of drug production, insecurity is being cultivated as to whether countries will be able to respond to a new wave of shortages of even more essential drugs.

2. Pricing

The turbulence mentioned above has led to a dramatic increase in the prices of materials, machinery, and energy, which threaten the existence and, nonetheless, expansion of operations of (mostly generic medicines) manufacturers given that the regulated prices for medicines have mainly remained unchanged or increased at a rate lower than that of other goods and services available at most markets, favoring exports to more competitive countries.

The “legal parallel trade” is also to blame for the shortcomings in the availability of medicines. The “direct to pharmacy” is like the parallel trade, another phenomenon threatening the supply chain and its monitoring.

Strategies to Tackle Medicine Shortages

The complexity of drug shortages depends on the product's life cycle, with innovative drugs protected by patents being less prone to experiencing shortages. At the same time, older medications that have few manufacturers and are less profitable are more susceptible.

This highlights the need for effective drug management strategies to ensure that the availability and accessibility of essential medications are maintained.

One solution to these challenges is to provide pharmaceutical manufacturers with a stable market through fixed-price purchasing commitments.

Some other successful models adopted councils or digital reporting systems to help monitor and respond to shortages showing the value of collaboration and information sharing.

Conclusion & Solutions Proposed

The WHO has taken significant steps to combat drug shortages globally by establishing comprehensive mitigation strategies.

These strategies operate at four distinct levels to overcome drug shortages.

1. Immediate solutions to tackle the current shortage of essential drugs.
2. Recognize the importance of operational improvements to mitigate the risk of future drug shortages.
3. Acknowledge the role of governmental policies in addressing drug shortages.
4. Emphasize the importance of education and training for all health professionals regarding effectively managing drug shortages.

By implementing these multi-level strategies, the WHO aims to tackle drug shortages comprehensively and address the complex challenges associated with global medication supply. The organization's efforts encompass immediate actions, long-term improvements, policy changes, and education to ensure the availability and accessibility of essential drugs for all populations worldwide.

Together, we can identify the best measures to prevent and address shortages, such as diversification, de-risking, and increasing manufacturing across different regions.

See you in the next edition!

Arar Notes is Bayan A. Arar newsletter issued monthly with the latest updates across HealthCare & Life Sciences. Read about this month’s insights and subscribe to get monthly updates on the latest in global health, Life Sciences, wellness, and more.