Over Christmas, a friend was visiting family in England and posted a photo on Instagram of stocked pharmacy shelves, brimming with children’s pain relievers. Like many American parents — myself included — he’d been disturbed by the shortages of children’s pain relievers and certain formulations of antibiotics.
Those shortages have continued into January, with parents at wit’s end and American lawmakers on the left and the right asking for accountability and answers from the pharmaceutical industry.
Many of the articles I’d read on the topic focused more on practical advice about what to do if you can’t access the medication your kid needs in the short term, but my friend’s post inspired me to dig deeper. Specifically, I wanted to know: Are these shortages mostly an American problem? And bigger picture, what’s causing them — are they happening because of Covid-era supply chain disruptions, or something else?
The quick and dirty answer: Medication shortages aren’t just an American problem, they aren’t limited to children’s medications, and in some instances were becoming a concern before 2020.
There have been stories in the past year about medication shortages in Germany, Canada and — despite those full shelves my friend found in London — the United Kingdom. And though it may seem as if it’s recent media coverage that’s making it appear as if there are more shortages of children’s medications than adult ones, a perusal of current and resolved shortages reported to the Food and Drug Administration shows just how prevalent shortages can be, and how many types of medication it affects.
So what’s going on? To start, “our markets are really fine tuned with a certain demand level,” said Dr. Mariana Socal, a physician and an associate scientist in the Bloomberg School of Public Health at Johns Hopkins University. So when there is an increased, unexpected demand, as there has been for children’s medications in certain parts of the country because of the recent confluence of flu, R.S.V. and Covid, pharmaceutical companies and retailers aren’t poised to respond very quickly.
That’s coupled with the outsourcing of production of most active pharmaceutical ingredients in drugs, something that’s been connected to the current amoxicillin shortage. The production of many of these active ingredients takes place in India and China, as well as European Union countries, noted Socal. If there are hold ups getting those active ingredients into the global supply chain, she said, that can lead to shortages of essential medications.
The maker of Children’s Tylenol and Children’s Motrin, Johnson & Johnson, told The Times there isn’t a nationwide shortage. What’s frustrating, though, is that currently there’s not an efficient way to redistribute children’s medications to parts of the country where stocks are low, said Socal. That’s because our drug distribution is highly concentrated among just three wholesalers, and they each “have their own proprietary way to allocate their inventory,” she said.
As Dr. Joshua Sharfstein, a physician and a vice dean for public health practice and community engagement at the Bloomberg School (and a colleague of Socal’s), put it: “The system has evolved to become very efficient, but not very resilient. People are focused on doing what they can do at the lowest cost for their part of the chain. The companies at each stage do their own thing, but they’re not building extra capacity because that’s expensive. They’re not holding on to huge stores, because that would be expensive, too.”
So can anything be done to mitigate these shortages? While the Consumer Healthcare Products Association said in a December statement that “C.H.P.A. member companies are running manufacturing facilities 24-7 to meet demand,” anecdotally, parents are still struggling to find the medications they need, though that may be ameliorated in the next few months.
It could take years and a concerted effort to fix the systemic problems. Darrell West, a senior fellow at the Brookings Institution, said the combination of supply chain challenges “has been a problem brewing for decades.” One thing we can do, he said, is to onshore some of the production of essential medication so that the United States can “control our own destiny” and be less reliant on far-flung suppliers. We can also “nearshore” some production to Canada and Mexico, or the United States territory Puerto Rico, as Ezekiel Emanuel suggests in an opinion essay for The Washington Post.
“Costs will go up, because it is more expensive to manufacture in the United States,” West said. “We have detailed health, safety and environmental rules.” But “it’s a cost worth paying, because it puts us in a stronger position to manage supply and demand.” One way our government could help offset some of these costs, he said, is through tax incentives.
Onshoring may not be a panacea, though, as we saw with the baby formula shortage of 2022, when a single American factory’s shutdown caused chaos. “My data really corroborates that onshoring is not the magic bullet for mitigating the supply chain problems,” said Socal.
Both she and West said we need more diversification of producers, and West said there’s reason to be optimistic that things will improve over time: “The good news is there are a number of American companies who have seen the problems of the global supply chain, and they are moving their production capabilities back to the U.S. or neighboring countries. It’s a longer-term challenge. We’re not going to be able to fix all those problems overnight.”
In the meantime, we may continue to see medication shortages, which is particularly gutting when it comes to our children. Sterling Elliott, a clinical pharmacist and an assistant professor of orthopedic surgery at Northwestern University’s Feinberg School of Medicine who has described the shortages of medications in the United States as “a very ugly scenario” that’s been ongoing for years, said the shortages have bubbled up into our consciousness because seeing little kids in harm’s way is so poignantly awful for parents. “There’s no worse feeling on the planet as a parent than the feeling that I cannot help my kid,” he said. Indeed.
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