The original question of the article on December 5 on the VOX website of the United States: Why does the United States always run out of drugs? As the richest country and one of the most important drug developers in the world, the United States should not run out of prescription drugs. However, the United States always does. It is reported that in the past few weeks, with the surge of respiratory infections, amoxicillin and oseltamivir are in short supply. Shortages also occur in drugs for various diseases throughout the medical system.
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In recent years, there has been a shortage of normal saline, morphine and anticancer drugs. The National Academy of Science, Engineering and Medicine of the United States released a report in 2022, saying, "The number of drugs in continuous shortage has been increasing and lasts longer." According to the report of the U.S. Food and Drug Administration, the root cause of this problem is related to the economic factors of the drug market itself.
No matter which kind of medicine is used, the reasons for the shortage are usually the same: either the shortage of raw materials or problems in pharmaceutical factories. The shortage of drugs in pharmacies is more likely to trigger media reports, but most of the drugs in shortage are actually generic injectable drugs used in hospitals, which usually only have one or two suppliers. Moreover, they are often cheap, which means that the companies that make them have no strong incentive to overproduce. The shortage of some drugs will directly lead to the death of patients. An Associated Press report in 2011 linked at least 15 deaths in the previous 15 months to the drug shortage. Even if it does not lead to death, the shortage of drugs will seriously affect the medical care that patients receive. For example, if there is a lack of induction drugs, pregnant women may need to undergo caesarean section with a longer recovery time.
Most drug shortages can be traced back to the shortage of raw materials, or problems in the pharmaceutical factory, such as machine failure, drug ingredient contamination, etc. Like infant formula, when production stops, it is difficult for the industry to make up for the gap. Most of the drugs in shortage are generic drugs, and only a few companies produce some generic drugs. If one of them has problems in the production process, it will mean that more than half of the expected supply suddenly disappears. Once the supply is interrupted, it is difficult to quickly fill the gap. These companies rely on extremely meager profits and huge pharmaceutical scale to maintain operation. As the production and storage of excess drugs have no practical economic significance for manufacturers, there is no emergency stock.
Shortages caused by distribution problems or increased demand are uncommon, but they do occur. For example, the strike of railway workers will make it impossible for drugs to be delivered to patients in time, and the surge in demand for related drugs at the beginning of the outbreak of the epidemic has also triggered a temporary shortage.
Whatever the reason, the shortage will have serious consequences. But this is not enough to force drug manufacturers to change their processes or start producing redundant drugs. This situation will not change unless the decision-maker completely changes the relevant rules.
However, under the existing system, it is impractical for the government to buy every kind of medicine in excess, and it is also meaningless for pharmaceutical manufacturers to maintain their reserves indefinitely. These solutions are all temporary measures, and will only be used when there is a shortage. The COVID-19 epidemic makes people more aware of the problems in the supply chain. Elin Fox, a pharmacist at the University of Utah who studies the problem of drug shortage, said, "If there is any 'bright spot' in the epidemic, it is that it illuminates these supply chain problems." Before officials take action, there will certainly be more shortages, and they may become more and more serious. (Author Dylan Scott, translated by Ding Ding)
