Medicine shortages recently reached record highs across countries in Europe and hit a 10-year peak in the US last year. Photograph: iStockPart way through her 23-year-old son’s chemotherapy, Kristin Caparra was told that one of the drugs key to his treatment – methotrexate – was running out.care, the drug is part of common chemotherapy to treat paediatric cancers. There is often no good alternative to the treatment.
“The whole system has a just-in-time principle and any rupture in that causes a downstream shortage,” says Rob Moss, a hospital pharmacy consultant in Utrecht, the Netherlands. “But the quality measures are so high and it’s so regulated that if there’s a quality defect, it’s harder for other suppliers to step in than in other industries.”
Dario Trapani, a doctor at Milan’s European Institute of Oncology, says that when he heard that a drug called paclitaxel, a “backbone for curing women with breast cancer”, was running short in Italy, he was scared. He has few good alternatives to the drug. Like globalised supply chains for other goods, this adds an element of uncertainty. “The more you are dependent on a producer far away, the more vulnerable you are to facing medicine shortages. Multiple things can happen from production until it arrives at the final distribution point,” says Mujaheed Shaikh, a professor of health governance at Berlin’s Hertie School.
An Indian pharmaceutical manufacturer, Intas, is a major supplier of finished dosage methotrexate to the US through its subsidiary Accord Healthcare. In 2022, Accord provided 35 per cent of the US’s methotrexate supply as well as more than half of the US supply of other key cancer drugs: carboplatin and cisplatin.
But the incident revealed “inherent structural weaknesses” in the market for sterile injectable drugs such as methotrexate, says Vimala Raghavendran, a pharmaceutical supply chain expert at US Pharmacopeia, an NGO. The moment something goes wrong, whether it’s a quality recall or a manufacturing issue or they can’t meet demand, everything goes bust
The severity of the methotrexate shortage has since abated. But experts say that more people will probably be affected by drug shortages in the near term, as the underlying causes remain unaddressed.
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