The COVID-19 pandemic has severely impacted the global drug supply chain, raising challenges for pharmacists, physicians, patients, manufacturers, and the health system. During Bioinsider’s recent virtual Friday Roundtable, Drug Shortage Challenges in the Time of COVID-19, experts in the field illuminated the severity of these challenges, and identified and brainstormed necessary actionable solutions. This discussion was moderated by Drs. Mina Tadrous (Scientist,Women’s College Hospital Institute for Health System Solutions and Virtual Care) and Barry Power (Editor-in-Chief, Canadian Pharmacists Association).
A background presentation revealed the underlying causes for drug shortages during COVID-19. Drug shortages are due to a breakdown in the balance of supply and demand. While drug shortages accompanied with COVID-19 have magnified some weaknesses in the supply chain, the shortages have largely been due to an increase in use and demand. One example discussed was the stockpiling of certain medications at the onset of the pandemic. Another example discussed was the increased need for critical care drugs due to increased hospitalizations of COVID-19 patients. The data highlighted that COVID-19 drug shortages are persisting longer than routine shortages, and noted shortages in salbutamol inhalers, hydroxychloroquine, and a number of sedation medications used in hospital intensive care units.
The critical questions posed:
- Is it possible to identify impending shortage signals for improved preparedness?
a. This question gives rise to the “many moving parts” dilemma, as the manufacturing of a drug requires several ingredients, yet there is no sole owner of the supply chain for each ingredient. Hence, if there was a signal that indicated supply chain shortages for particular ingredients, preventative and/or alternative measures could be identified and acted on before shortages are felt by the consumer.
b. The Health Canada Drug Shortage Unit identified high-demand drugs during COVID-19 to generate a priority list (known as the Tier 3 list) of drugs that must not have supply chain shortages.
- During the pandemic, Health Canada’s Drug Shortages Unit holds regular updates on Tier 3 listed drugs.
- How do we address the lack of global data sharing on drug supply and challenges?
a. One solution is the development of a grid that identifies medicine production and supply chain groups who may be able to solve an issue as it arises (i.e. identify alternate suppliers for an ingredient should there be a production issue).
- Challenges for this initiative would be including everyone on the grid.
- However, the automotive industry utilizes a grid system to coordinate thousands of parts products by multiple manufacturers.
b. Sharing global data may be an important way to identify unusual purchase patterns that could indicate stockpiling.
- How can we optimize the supply chain to be more robust?
a. Supply chain redundancy: There was a general agreement that redundancy is needed in the supply chain, especially in critical care agents, so that these never run out.
- Currently, there is a high concentration of drug ingredients and products that are reliant on only a few numbers of countries.
- Lack of redundancy has been specifically highlighted during the COVID-19 pandemic, shining a light on the issue of security of drug supply versus savings due to lower costs.
b. Increase domestic production: Feasibility is unclear as many factors are involved, including policy dilemmas requiring a balance of desire for low-cost drugs, the need to have a viable manufacturing business, and a secure supply of medications in times of crisis. Case-examples of non-profit projects to fill the gap were highlighted.
c. Transparency: There is a need for transparency in the supply chain along with the cooperation of multiple stakeholders to address many of the issues that contribute to drug shortages.
Action items should we strive to take:
- Acquire and use data from the supply chain for predictive analysis.
- Diversify where medications are coming from (i.e. non-profit manufacturers).
- Develop a one-stop shop for issues related to shortage (e.g. Health Canada initiatives).
- Perform scenario planning, with pharmaceutical companies a part of the discussion to provide input on the manufacturing process.