Drug shortages and national security : NPR

SCOTT DETROW, HOST:

We want to focus now on a topic that got quite a bit of attention on Capitol Hill recently – drug shortages. This past week, the Senate Homeland Security Committee put out a new report and held a hearing on the link between drug shortages and national security. And that might not be news to you. It’s definitely not news to parents like me who spent some anxious nights this winter driving from drugstore to drugstore to track down infant pain relievers or for people dealing with extended Ritalin shortages lately. But the report put this all into context and said it’s become a much broader problem and includes drugs that are critical for providing care in hospitals and doctor’s offices – think antibiotics, sedatives and IV fluids. The big takeaway from the hearing – a warning that if the U.S. doesn’t beef up its pharmaceutical supply chain, meaning how it makes and gets and distributes medicine, the consequences could be disastrous.

To help us better understand the issue, we’ve called Marta Wosinska. She has years of experience thinking about the distribution of pharmaceutical drugs, and right now she’s a visiting fellow at the Brookings Institution, a policy think tank based in Washington, D.C. I spoke with her just after that Senate hearing and asked what concerns her the most about drug shortages right now.

MARTA WOSINSKA: Well, there are two things that worry me. No. 1 is that we have had shortages of certain drugs for well over a decade, and we have made very little progress in trying to address the root causes of those shortages. What also worries me is that the threats to our supply chains are increasing, and those are the geopolitical risks that the report really focused on.

DETROW: So this is a long-term trend. But is it fair to say the pandemic made it worse, or is it fair to say other factors in the past two years have made it worse?

WOSINSKA: A lot of the supply chain disruptions during the pandemic were really large demand shocks, where there was tremendous demand for certain products. I would say that when you look at the history of drug shortages that we have had in the United States, they typically have been caused by supply disruptions. With the onset of the pandemic and then the fallout with the triplemic (ph) that we experienced at the beginning of this winter, this has been more of a trend towards demand shocks, where there is really a large demand for a particular drug and production just does not keep up.

DETROW: How realistic is it to do what the lawmakers are calling for and change the drug supply chain so that it’s coming more from inside the U.S.?

WOSINSKA: Oh, that’s hard.

DETROW: Yeah, ’cause it’s a good soundbite, but your response makes it seem like it’s not something happening anytime soon.

WOSINSKA: It’s not happening anytime soon because our supply chains are incredibly complex and enormous. So for us to think about bringing this enormous – enormous – supply chain back into the United States, it’s just simply not feasible.

DETROW: Given that, as you said, most companies are going to be doing everything they can to keep their margin ends, which are small to begin with, to keep costs down – given that these are global manufacturing networks, and you said you don’t see that changing anytime soon, what would your top suggestions be to make this supply more reliable and to cut down on some of these shortages that we’ve been seeing in recent years?

WOSINSKA: So the government can help engage in a number of ways. One of the ways to do this is to enable greater transparency around manufacturing processes and manufacturing reliability. It’s really important to get the buyers both empowered, but also potentially nudged towards really thinking about where they source product. To the extent that the government is going to be providing interventions – let’s say paying for buffer inventory for certain drugs, or if the government were to create subsidies for bringing certain products or certain key starting materials into the United States, the government needs to think about which ones are the most important.

For us to do this, we need to have much stronger analytics and much better access to data, much of which we don’t have. We know where our finished dose facilities are, the active pharmaceutical ingredient facilities are, but we don’t know where our inactive ingredients are manufactured. We don’t know where our key starting materials are manufactured. Without having that insight, it’s really difficult for the government to prioritize what to really support.

Another piece that we need to rethink is actually the FDA’s essential medicines list. That list was developed in response to the pandemic, and it asked the FDA to create a list of drugs that we need in a pandemic or if there is a CBRN threat – so radiological, biological, nuclear. This is a set of drugs that we need if there is a crisis of a certain kind. It’s not the same as a list of drugs without which we will have a public health crisis, so that’s a starting point for us so that we can start thinking about what should we onshore, for example.

DETROW: That was Marta Wosinska. She’s a visiting fellow at the Brookings Institution, where she focuses on health policy. Marta, thank you so much for bringing your expertise to us today.

WOSINSKA: Thank you so much for having me.

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