Drug Shortages: The next crisis in the pandemic
While the COVID-19 pandemic has exposed many systemic flaws in our healthcare system, the critical drug shortages that are starting to cripple patient care across North America have not received much attention yet.
The first cracks to appear were the battles over personal protective equipment (PPE), where years of outsourcing and penny-pinching left many countries fighting over scarce Chinese-made mask supplies. We put all of our frontline providers and patients at risk to shave pennies off the cost of simple paper masks, which ironically are made with our own exported pulp-paper products. Since then we have seen provincial and federal governments scrambling to secure supplies with varying levels of success.
Now we are facing a scramble for drugs.
The occasional scarcity of specific generic drugs has been occurring for years and served as a warning sign of systemic flaws. Recently, Health Canada published a long list of critical care drugs that are either actively experiencing shortages or are predicted to be in dire shortage in the near future, meaning fewer patients may have access to modern medicines and potentially more unnecessary deaths in a system that is already reeling from devastating outbreaks in long-term care homes.
The main culprit is Canada’s long medical supply chain. Similar to PPE, Canada relies heavily on manufacturing plants in foreign countries, mainly in China and India, to provide us with the raw materials and/or the final end-use product. These raw materials are the precursors that precede the production of the Active Pharmaceutical Ingredient (API) and lead to the final product. The Health Canada list indicates that the vast majority of the precursors as well as APIs are sourced from these countries. India has already restricted export of certain precursors, partly explaining our supply shortages now, and other countries may follow suit should local outbreaks worsen. This is exactly what happened with masks as China, Taiwan and other countries limited the export of PPE when our needs were most acute.
It may have made sense at one point to outsource production of these drugs to reduce costs, allowing patients in Canada to benefit from lower retail prices. However, what made economic sense in an earlier era has left us in a strategically and medically vulnerable position.
To compound matters, frontline pharmacists, physicians and even hospitals and retail pharmacies have little visibility into these complicated supply chains, meaning shortages can be sudden and unexpected. Many hospitals do not have a real-time tracking system of their drug stock and update their supply levels manually. When they discover shortages, they have to resort to calling around or emailing colleagues to fill gaps in a time-consuming and haphazard fashion.
Thankfully, the crisis seems to have led to some degree of mobilization in both the private and public sectors and we know Health Canada is scrambling to secure supplies from across the world. All bets are off should our crisis escalate or if the U.S. or others decide to unilaterally cut off supply.
There are some short-term and long-term solutions that should be implemented. First, in addition to supporting government efforts at securing drug supplies, we need hospitals, pharma companies and group-purchasing organizations to allow more transparency into their supply chains. We need to know in advance when and where the shortages are going to be, not two months after the supply dries up.
Second, we must bring drug production back to Canada; we certainly have the requisite skills and know-how to produce locally. Costs will be higher and governments will need to guarantee orders to ensure we do not return to the same insecure system when the pandemic ends. We could have local production of many of these medications by the end of the year if we acted quickly.
Third, we need to build and secure local vaccine production. The scramble to produce vaccine doses, once one of the many candidates being tested is validated, is going to make the fight over PPE look tame. A vaccine is truly the only long-term way for a return to normal economic activity. Each day of delay is billions of dollars lost to our economy.
These goals are achievable but will require long-term coordination and planning as well as financial commitments from the business community and government. COVID-19 has presented a singular challenge to the health and well-being of Canadians; self-sufficiency in medications and vaccines is one of the strongest ways to meet that challenge head on.