Between 2021 and 2024, medication shortages emerged as a critical global health issue, with both developed and developing countries experiencing significant disruptions in the availability of essential drugs and medical supplies.

In the United States, drug shortages reached a record high of 323 medications in the first quarter of 2024, according to data from the American Society of Health System Pharmacists and the University of Utah Drug Information Service.

Among the most concerning shortages were sterile injectable generic drugs, including cancer chemotherapy medications and emergency drugs used in hospital settings.

The five categories of drugs most affected by shortages included chemotherapy drugs, central nervous system stimulants, antimicrobials, hormonal agents, and intravenous fluids.

By the end of 2022, the United States faced a five-year peak in drug shortages, with nearly 300 pharmaceutical products in limited supply.

Specific products such as sodium chloride solution, the antibiotic amoxicillin, and albuterol inhalation solution were reported to be in short supply, impacting both hospital and outpatient care.

In the European Union, shortages of antibiotics like amoxicillin, as well as medications for colds, flu, respiratory infections, and pediatric treatments, were widely reported.

More than half of hospital pharmacists in the United States reported critical shortages of chemotherapy drugs, with nearly all acknowledging broader medicine supply gaps.

Over a dozen cancer drugs, including cisplatin and carboplatin, were in shortage, severely affecting treatments for lung, breast, prostate, and gynecologic cancers.

Additionally, shortages extended to steroids, hormonal drugs, and oral liquids such as lidocaine, ibuprofen, and amoxicillin, with one in five hospital pharmacists reporting gaps in these supplies.

Globally, the shortage of antibiotics was attributed to an increase in infectious diseases, with 28 of the 35 countries monitored by the World Health Organization reporting deficiencies in penicillin-type drugs.

Other medications affected by shortages included diabetes treatments like Ozempic and Mounjaro, adrenaline for allergy management, and essential chemotherapy drugs.

The nationwide shortage of ADHD medications in the United States was described as a significant challenge for both clinicians and patients.

The causes of these shortages were multifaceted, often involving manufacturing and quality control issues, supply chain disruptions, and increased demand for specific drugs.

For instance, a factory closure in India following an FDA inspection that identified quality issues led to a shortage of a generic chemical drug, highlighting the vulnerability of global supply chains.

In Egypt, despite manufacturing over 90% of its medicines domestically, shortages persisted due to reliance on imported raw materials and smuggling to neighboring conflict zones.

Smuggling brokers exploited price differences by diverting Egyptian medicines abroad, particularly to conflict areas, where they were sold at exorbitant prices.

A shortage of hard currency in Egypt further exacerbated the disappearance of medicines from the local market, as pharmaceutical companies struggled to import active substances.

In the United States, the relocation of drug production to countries like China and India was identified as a contributing factor to supply chain vulnerabilities.

Increased demand due to a high prevalence of respiratory diseases, coupled with insufficient production capacity, also played a role in exacerbating shortages.

A study in Spain revealed a 38% increase in drug shortages over the past year, driven by inflation, high energy costs, raw material shortages, and lingering pandemic-related impacts.

The pandemic further strained pharmaceutical manufacturers, with high energy prices reducing company profits and limiting production capacity.

Countries failed to anticipate the surge in respiratory infections during the first year without widespread mask usage, leading to increased demand for medications.

In the United States, fragmentation in the drug supply chain was identified as a major contributor to recurring shortages.

The impact of these shortages on patients and healthcare systems was profound, with more than half of treatment gaps lasting over two years and affecting at least half a million patients, many of whom were elderly.

In Egypt, the shortage of vital medications, including stents, heart drugs, diabetes treatments, and tumor therapies, exacerbated patient suffering in public hospitals.

A severe lack of anesthetic drugs, dental medications, and nephrology treatments threatened surgical operations and increased hospital waiting lists, potentially leading to life-threatening complications.

In Jordan, medication shortages posed significant health, economic, and social challenges, threatening patient safety and the overall quality of healthcare.

Economic implications included increased costs for both health systems and patients, as well as referrals to private hospitals, which strained other budgetary allocations.

Healthcare workers faced heightened pressure due to patient complaints and inquiries about unavailable drugs, further straining the system.

Social repercussions included increased anxiety and stress among patients and families, reduced trust in healthcare systems, and financial burdens from sourcing medications outside hospitals.

In the United States, one in three health systems reported delaying, canceling, or rationing care due to drug shortages, often resorting to alternate medications to treat patients.

Patients undergoing chemotherapy faced uncertainty about receiving life-saving treatments, as clinicians struggled to guarantee drug availability.

The emotional toll on cancer patients was significant, as they navigated life-changing diagnoses alongside the uncertainty of treatment access.

Smaller community healthcare sites were disproportionately affected by shortages due to limited purchasing power and the inability to stockpile medications.

Socioeconomic disparities further exacerbated the impact, as patients in underserved areas often lacked the means to travel to larger centers with better resources.

Healthcare providers faced difficult decisions about prioritizing limited drug supplies, such as allocating them to curative treatments over palliative care.

In response to these challenges, various mitigation strategies were implemented globally, including efforts to improve coordination and communication within supply chains.

The Egyptian government coordinated with pharmaceutical companies and the unified purchasing authority to secure foreign exchange resources and ensure the availability of raw materials.

The FDA in the United States issued draft guidelines requiring manufacturers to notify the agency at least six months before ceasing drug production or as soon as possible if six months' notice was not feasible.

Governments in Europe promoted the sale of generics, substituted requested medicines with similar alternatives, and modified drug formulations to address shortages.

The European Commission announced plans to revise pharmaceutical legislation to include stricter supply obligations, earlier notifications of shortages, and improved public communication about stock availability.

In Taiwan, the government launched a 'Drug Market Monitoring System' to strengthen pharmaceutical supply monitoring and enable pharmacists to quickly query inventory.

The FDA temporarily allowed overseas manufacturers to import chemotherapy drugs like cisplatin to address critical shortages in the United States.

Cancer hospitals adjusted by ensuring sufficient medication for ongoing treatment courses and modifying regimens for new patients starting chemotherapy.

Pharmacists managed shortages by offering therapeutic alternatives, purchasing different vial sizes or concentrations, and rationing medicines to extend supplies.

The White House proposed a budget of $3.26 billion to $5.11 billion over the next decade to address drug shortages, pending Congressional approval.

Policymakers suggested increasing the price of generic drugs to attract more manufacturers as part of a long-term solution to drug shortages.

Recommendations also included granting the FDA greater authority to access information about drug shortages and requiring manufacturers to be transparent about supply chain issues.

The American Society of Health System Pharmacists advised the federal government on measures such as diversifying supply chains and increasing transparency to mitigate future shortages.

Between 2021 and 2024, medication shortages emerged as a critical global health issue, with both developed and developing countries experiencing significant disruptions in the availability of essential drugs and medical supplies.

Title:

Content: FDA gave instructions to pharmaceutical manufacturers to prevent the risk of defects
The FDA has released a draft guideline that will allow pharmaceutical manufacturers to more accurately report disruptions to the production of drugs and APIs.
In particular, it specifies who should contact the regulator in case of a failure in production and on which products it is necessary to transmit information.
The U.S. Food and Drug Administration (FDA) has issued draft guidelines to pharmaceutical manufacturers to prevent the risk of flaw.
According to the instructions, they will notify the agency of changes in the manufacturing process of drugs, biological products or active pharmaceutical ingredients (API).
In the United States, FD & C. It requires manufacturers to notify the agency of interruptions in the supply of products or APIs.
The FDA ’ s new guidelines provide clarifications.
Manufacturers must submit a notice to the FDA at least six months before stopping drug production, which could lead to their shortages on the market.
If it is not possible to notify the agency six months in advance, it should be done “as soon as possible ”.
If interruptions in production may affect the supply situation, the manufacturer should assess the situation only on the basis of its capabilities.
It should not take into account the capacity of other manufacturers, the amount of product on the market or market demand.
The guidelines also state what specific product or API information manufacturers should report when informing the FDA.
CBS, citing a report from the US Senate, writes that by the end of 2022, the shortage of drugs in the US had reached a five-year peak and affected almost 300 pharmaceutical products.
This is due to the fact that the United States moved production to China, India and other countries.
According to the American Society of Health System Pharmacists, products such as sodium chloride solution, the antibiotic amoxicillin and albuterol inhalation solution are now in short supply.
Nikolay Sokolov
pharmvestnik

In the United States, drug shortages reached a record high of 323 medications in the first quarter of 2024, according to data from the American Society of Health System Pharmacists and the University of Utah Drug Information Service.

Title:

Content: General Supervision
Elham Aboul Fath
Editor-in-Chief
Thank you for your patience.
General Supervision
Elham Aboul Fath
Editor-in-Chief
Thank you for your patience.
An Unexpected Catastrophe in the World ’ s Largest Country: The Complete Story of U.S. Drug Shortages
The deficit is at a record level.
According to data from the American Society of Health System Pharmacists and the University of Utah Drug Information Service, organizations began tracking drug shortages for the first time in 2001. Steady since 2021 – now reaching a record high of 323 drugs in the first three months of 2024.
Paul Abramowitz, CEO of the American Society of Health System Pharmacists, wrote in a blog post on Thursday: “It ’ s been a long time to end drug shortages, ” and wrote:“ All drug classes are vulnerable to shortages, some of the most worrisome shortages include sterile injectable generic drugs, including cancer chemotherapy drugs and emergency drugs stored in hospital vans and procedural areas. It is dangerous for doctors and patients. ”
In addition to the 32 chemotherapy drugs that are deficient, the five categories of drugs with the greatest deficiency include central nervous system stimulants, antimicrobials, hormonal agents, and intravenous fluids. [1] The Drug Deficiency Database maintained by the American Society of Health System Pharmacists and the University of Utah is based on voluntary reports from practitioners, patients, and others that have been confirmed by manufacturers. The U.S. drug is in short supply, because it captures broader effects on service providers and patients.
The crisis has lasted a year and a half.
More than half of the treatment shortages have lasted for more than two years, according to an analysis by health consultancy IQVIA, and the average shortage affects at least half a million patients, many of them elderly, according to the US Office of Health and Human Services under the Assistant Secretary for Planning and Evaluation, which shared its analysis with Congress in May.
Growing demand can play a role in drug shortages, as with the recent shortage of weight-loss drugs, but often manufacturing and quality problems, such as supply chain gaps and downtime, are the root cause. And varied.
But the American Society of Health System Pharmacists has “serious concerns ” about parts of this proposal, especially financial sanctions imposed on hospitals that lack the resources to comply with the recommendations, Abramowitz wrote:“ We all know that managing shortages is not enough and is not a sustainable solution to the worsening crisis, and there is still a lot of work to be done at the federal level to fix the root causes of drug shortages. ”
Why Shortage Occurs
Shortages can be caused by high demand, as with the recent shortage of weight-loss drugs, but this is not usually the main problem.
The FDA also blames manufacturing and quality problems, supply chain gaps, and downtime, and Dr. Emily Tucker, a drug shortage expert and an assistant professor of industrial engineering at Clemson University, says that when there is an indication of shortages, large health systems often also proactively place large orders, adding to the system ’ s stress.
“I don ’ t blame anyone.
“When I talk to all the stakeholders – whether it ’ s wholesalers, manufacturers, or the government – everyone wants this problem to end, ” she said.
Lack of transparency
Dr. Julie Grallo, chief medical officer and executive vice president of the American Society of Clinical Oncology, told the House Committee earlier that the shortage puts providers in a terrible position: “The drug shortage crisis is forcing providers to make impossible choices, and it is also hindering the development of new drugs. Health drugs are purchased only on a price basis, and manufacturers do not have to disclose the source of their acquisition of the ingredients.
The shortage of this generic chemical drug came due to the closure of one factory in India that manufactures the active ingredient after a surprise FDA inspection found “significant quality issues, ” says Jarallo:“ We didn ’ t know, and there was no transparency regarding the company ’ s supply of the majority of active pharmaceutical ingredients to all manufacturers across the board.
Knowing this in advance, we could have responded much faster, ” Dr. Steven Schundlemeyer, director of the PRIME Institute of the University of Minnesota School of Pharmacy, which focuses on economic and management issues, told the committee that as with defense contractors in the United States, New Zealand requires manufacturers to disclose their suppliers, and that information is required.
Easily accessible in the database.
Related Topics

Among the most concerning shortages were sterile injectable generic drugs, including cancer chemotherapy medications and emergency drugs used in hospital settings.

The five categories of drugs most affected by shortages included chemotherapy drugs, central nervous system stimulants, antimicrobials, hormonal agents, and intravenous fluids.

By the end of 2022, the United States faced a five-year peak in drug shortages, with nearly 300 pharmaceutical products in limited supply.

Specific products such as sodium chloride solution, the antibiotic amoxicillin, and albuterol inhalation solution were reported to be in short supply, impacting both hospital and outpatient care.

In the European Union, shortages of antibiotics like amoxicillin, as well as medications for colds, flu, respiratory infections, and pediatric treatments, were widely reported.

Title:

Content: There is not enough medicine in the EU
19 January 2023, 05: 20
ASTANA.
KAZINFORM - The European Union is suffering from a shortage of medicines.
Deficiency of antibiotics, such as amoxicillin, drugs against colds, flu and other respiratory infections, as well as some drugs for children, reports MIA "Kazinform" with reference to euronews.com.
In most countries, the situation is considered critical, but since such goods from pharmacies do not disappear at all, citizens are not advised to make stocks.
Doctors note a weakening in the population of natural immunity due to protection against coronavirus such as social distancing.
The main reasons for the sharp increase in demand, which have been identified, is the high prevalence of respiratory diseases with a lack of production capacity.
As pharmaceutical issues are being addressed at the national level, Governments are already taking steps to overcome the shortage
These measures include the sale of generics and the replacement of requested medicines with similar ones.
In some countries, some formulations have been changed, for example, drugs are offered in the form of syrups instead of tablets, so that children are more willing to take them.
"Pediatric drugs are generally now less available in the form of conventional tablets," said Steffen Tierstrup, chief medical officer of the European Medicines Agency. "Therefore, where children are more ill, the need for pediatric drugs is higher than for adult drugs."
A recent study showed that the shortage of drugs in Spain increased by 38% over the year.
The decline in their production was affected by inflation, high energy prices, shortages of raw materials and the effects of the pandemic.
“We need diversification, ” said Ilaria Passarani, head of the EU Pharmaceutical Group.“ Of course, it would be useful to return to Europe the production of some critical materials, such as active ingredients.
But we can't return all the production of all the materials we use for drugs.
This entails problems such as the increase in pharmacy prices associated with the implementation of environmental laws, labor laws, which are not necessarily enforced in other regions. ”
In March, the European Commission will present a revised version of the EU pharmaceutical legislation, which will include stricter supply obligations, earlier notification of shortages and seizures of medicines, and better informing the public about available stocks.
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More than half of hospital pharmacists in the United States reported critical shortages of chemotherapy drugs, with nearly all acknowledging broader medicine supply gaps.

Title:

Content: As drug shortage list grows, many hospitals face tough decisions on rationing care

More than half of hospital pharmacists are reporting a critical shortage of chemotherapy drugs and nearly all are reporting overall medicine supply gaps as prescription drug shortages near an all time high, according to a new survey.

Hospital pharmacists said drug shortages have forced 1 in 3 health systems to delay, cancel or ration care or switch to alternate drugs to continue to treat patients. And 99% are reporting some drug supply shortages, an American Society of Health-System Pharmacists survey of more than 1,000 pharmacists released Thursday found.

The organization reported shortages of 309 drugs, near the all-time high of 320 shortages in 2014. The scarcity of key drugs is prompting hospitals to find or substitute drugs and change treatment plans as needed.

“In some cases, there are no alternatives to the affected drugs, which puts patients at risk," ASHP Chief Executive Officer Paul W. Abramowitz said in a statement. "This issue requires quick action from Congress to address the underlying causes of shortages and ensure patients have the medications they need.”

Cancer drug shortages

In June, the Food and Drug Administration said it will temporarily allow overseas drug manufacturers to import some chemotherapy drugs.

The FDA allowed Qilu Pharmaceutical, a drug manufacturer in China, to import the injectable chemotherapy drug cisplatin in 50-milligram vials. Toronto pharmaceutical company Apotex Corp. will distribute the medication in the United States.

More than a dozen cancer drugs have been in shortage in recent months, including cisplatin and carboplatin, used to treat lung, breast, prostate and gynecologic cancers. The National Cancer Institute said cisplatin and similar drugs are prescribed for 10% to 20% of all cancer patients.

In June, the National Comprehensive Cancer Network released a survey of 27 academic cancer centers that found 93% reported shortages of carboplatin and 70% faced shortages of cisplatin.

When cancer hospitals face such shortages, they attempt to make sure there's enough medication for patients to finish the course of treatment, said Mike Ganio, ASHP's senior director of pharmacy practice and quality.

Cancer hospitals facing such shortages might change medications for new patients starting on chemotherapy, said Ganio, a former pharmacy manager at an academic cancer center.

"You try to keep that patient on the same regimen as much as you can, unless they're failing it for some reason, and then you would switch," Ganio said.

Steroids, hormonal drugs also in short supply

More than 1 in 5 hospital pharmacists also reported shortages for steroids, hormonal drugs and oral liquids such as lidocaine, ibuprofen and amoxicillin.

A smaller number of pharmacists said heart medications, emergency prefilled syringes and drugs used for intensive care unit patients were in short supply. Others reported shortages of attention deficit hyperactivity disorder medicines, antimicrobial drugs and injectable opioids.

In all, about two-thirds of pharmacists said the shortages were "moderately impactful," which means they are managing shortages but patients are affected.

Pharmacists are managing the shortages by offering therapeutic alternatives, buying different vial sizes or concentrations and rationing medicines.

This article originally appeared on USA TODAY: Survey: Drug shortages are widespread, hospitals ration care

Over a dozen cancer drugs, including cisplatin and carboplatin, were in shortage, severely affecting treatments for lung, breast, prostate, and gynecologic cancers.

Additionally, shortages extended to steroids, hormonal drugs, and oral liquids such as lidocaine, ibuprofen, and amoxicillin, with one in five hospital pharmacists reporting gaps in these supplies.

Globally, the shortage of antibiotics was attributed to an increase in infectious diseases, with 28 of the 35 countries monitored by the World Health Organization reporting deficiencies in penicillin-type drugs.

Title:

Content: Experts have recorded a shortage of antibiotics in the world due to the increase in the number of infectious diseases.
On December 21, writes the Financial Times with reference to the head of the group of the World Health Organization (WHO) for the supply of medicines and ensuring access to them Lisa Hedman, reports Day.Az.
Twenty-eight of the 35 countries for which WHO collects data are deficient in penicillin-type drugs.
In the United States and Canada complained about the lack of amoxicillin.
Less is known about the situation in poor or small countries, according to Hedman.
It is noted that in addition to the difficulties experienced by pharmaceutical manufacturers in the pandemic, the current situation is complicated by high energy prices, and this leads to a decrease in profits of companies.
In addition, countries, according to Hedman, did not expect that in the first year without masks, respiratory infections would hit the population so hard.
In addition to antibiotics, pharmacists also complain about the lack of painkillers, drugs for tuberculosis and drugs for skin infections.

Other medications affected by shortages included diabetes treatments like Ozempic and Mounjaro, adrenaline for allergy management, and essential chemotherapy drugs.

Title:

Content: Meitu
The first quarter of the United States serious drug shortage 323 drugs urgent cancer patients also have to be diverted and rationed!
CHU HENG NETWORK NEWS CENTER 2024-04-16 10: 42
According to the latest data from the American Society of Health System Pharmacists (ASHP) and the Utah Center for Drug Information Services, a total of 323 drugs in the United States were in severe shortages in the first quarter of this year, surpassing the record of 320 in 2014.
Among the drugs affected are the widely used diabetes drugs Ozempic and Mounjaro, the allergy treatment drug adrenaline, the common antibiotic amoxicillin for children, chemotherapy drugs and injections commonly used in hospitals in intensive care.
ASHP CEO Paul Abramowitz said in a statement that almost all categories of drugs are facing shortages, with non-patented sterile injectable drugs, including cancer chemotherapy drugs, and emergency drugs stored in hospital emergency vans and operating areas, the shortage of such drugs is the most worrying.
According to the American Cancer Society, chemotherapy is one of the top five drugs most affected by the shortage, which threatens to have a devastating impact on patients, and some hospitals and clinics say doctors have had to divert patients to ration their medications because of a shortage of some chemotherapy drugs.
In addition, ASHP noted that the continued nationwide shortage of ADHD drugs is “a problem for clinicians and patients. ”
The shortage of popular drugs is even more acute, with Mounjaro, the diabetes drug known as the “slimming pill ”, already in dire straits.
In response, Lilly said that the “unprecedented surge in demand ” for Mounjaro and its similar drug Zepbound has led to a shortage in the market, which the company is struggling to cope with.
Lilly is ramping up investments to boost production at Mounjaro and Zepbound in the second half of 2024.
The company said it expects intermittent supply disruptions in the near term due to unprecedented demand.
How to cure the drug shortage
The last major “drug shortage ” in U.S. history occurred in 2014, and it has only been alleviated in the years since.
Since 2021, the drug shortage situation seems to be increasing, and scholars in the field of medical health and economics in the United States believe that the reason for most drug shortages in the United States is the fragmentation of the drug supply chain.
The White House this month proposed spending between $3.26 billion and $5.11 billion over the next decade to help address the nation ’ s drug shortage.
The bill requires approval and funding from the U.S. Congress.
U.S. researchers and policymakers believe that a complete solution to the “drug shortage ” may require changes to the business model of the U.S. pharmaceutical industry, including measures to increase the price of generic drugs to attract more drug manufacturers.
Policymakers recommend giving the FDA more power to access more information about drug shortages and impending shortages.
Currently, the FDA relies primarily on phone calls to manufacturers asking if they can increase their supply to understand the situation.
The American Society of Health System Pharmacists said it is working with the federal government to advise the government on measures to address the drug shortage, including that Congress should require manufacturers to be more transparent on any supply chain issues and encourage more diversity in supply chains.
According to Abramowitz, “The federal government still has a lot of work to do to fundamentally address drug shortages, and the American Society of Health System Pharmacists will continue to engage regularly with policymakers to guide them in drafting and passing new legislation to address drug shortages and continue to advocate vigorously for proven solutions on behalf of our members. ”

The nationwide shortage of ADHD medications in the United States was described as a significant challenge for both clinicians and patients.

The causes of these shortages were multifaceted, often involving manufacturing and quality control issues, supply chain disruptions, and increased demand for specific drugs.

For instance, a factory closure in India following an FDA inspection that identified quality issues led to a shortage of a generic chemical drug, highlighting the vulnerability of global supply chains.

In Egypt, despite manufacturing over 90% of its medicines domestically, shortages persisted due to reliance on imported raw materials and smuggling to neighboring conflict zones.

Title:

Content: Chairman of Wafd Party
Dr. Abdul Sindh Yamama
Chairman of the Board of Directors
Dr. Ayman is an accountant.
Editor-in-Chief
I'm sorry.
My grandfather, Zainuddin.
Chairman of Wafd Party
Dr. Abdul Sindh Yamama
Chairman of the Board of Directors
Dr. Ayman is an accountant.
Editor-in-Chief
I'm sorry.
My grandfather, Zainuddin.
Smuggling burns drug stability
Libya and Sudan are the main destinations.
And the profits are huge.
Deficiencies include stents, heart medications, diabetes, pressure, and tumors.
It is an undeniable fact that the Egyptian pharmaceutical market is experiencing a crisis of shortage of some vital items on which citizens depend mainly, and at all levels, which exacerbated the suffering of patients in public hospitals affiliated to the government, which receive subsidized medicines at low prices, so that the so-called alternative class becomes a citizen ’ s refuge, to get the necessary dose of medicine, to alleviate his health suffering or save his life.
At a time when it is assumed that more than 90% of medicines are manufactured in Egypt, citizens' complaints about the lack of many medicines and medical supplies in the markets and hospitals are escalating to the extent that deputies submitted a number of requests for briefing through the deputies, stressing that the crisis lies in the raw material itself and imported in dollars.
And the pressure.
Thyroid and sugar.
The main reasons lie in the importation of 95% of raw materials in addition to the presence of “smuggling brokers ” whose mission is to smuggle Egyptian medicine to neighboring conflict countries, especially Libya and Sudan, in order to sell it abroad at exorbitant prices, and to reap huge profits, according to some pharmacists and specialists. In addition to Sudan ’ s import of Egyptian medicine in hard currency, especially with the licenses of Egyptian medicine compared to others and the stopping of factories in neighboring countries because of their conflicts.
According to Ali Abdullah, head of the Egyptian Society for Pharmaceutical Studies (an NGO), the lack of medicines and their disappearance from the local market is a real crisis in case of smuggling, such as insulin, tumors, anesthesia, surgical supplies, serums and vaccines.
The shortage of hard currency in Egypt is also one of the reasons for the disappearance of medicines.
Mahfouz Ramzi, head of the Pharmaceutical Manufacturing Committee at the Cairo Pharmacists Syndicate, pointed out that there are organized gangs that smuggle medicine to countries of conflicts and wars, explaining that “most operations are conducted through land border roads, and the Egyptian Drug Authority is responsible for inspecting companies, factories and any pharmaceutical institution, to ensure that medicines produced in Egypt are in the normal sequence until they reach pharmacies. ”“ Some smuggling professionals deal with drug stores, where they buy large quantities of medicines, take advantage of discounts on them, and then smuggle them abroad to take advantage of the price difference. ”
The Executive Director of the Egyptian Center for the Right to Medicine, Mahmoud Fouad, confirmed that "the drug stores have turned into an illegal business and a back gate for drug smuggling and expired drug trade, as most of them are not licensed and sold without invoices, and are not subject to the umbrella of the Ministry of Health, in addition to the lack of health standards required to practice the profession of pharmacy, after some stores are run from apartments away from the eyes of the Ministry of the control bodies. 90% of its owners are not pharmacists. ”
“Are these stores registered with the Ministry of Health?
And are they subject to pharmaceutical inspection or from the Drug Control and Research Authority? ”, stressing that most of the small pharmacies in the villages “do not have the ability to buy medicine from distribution companies, which makes them resort to buying from stores after agreeing on specific facilities and periods for payment, ” pointing out that“ popular medicines in Egypt are the most smuggled abroad. ” From 250 pounds ($8 at the official exchange rate).
According to Dr. Ashraf Hatem, Chairman of the Health Committee in Parliament, it is a social responsibility, and priorities must be set, and all parties sitting together may help to solve the crisis, in light of the apparent shortage of a number of medical drugs, and his demand that the Drug Authority publish periodically and daily alternatives to the missing medicines in the absence of the original medicine. In addition, the pharmaceutical industry continues to operate and produce.
For all this and for the continuation of the crisis of drug shortage it was necessary to search and investigate the causes and solutions!
During the meeting of Gamal al-Laith, Chairman of the Chamber of Pharmaceutical Industry at the Federation of Industries, in the presence of Minister of Health Dr. Khaled Abdel Ghaffar, the Governor of the Central Bank, Hassan Abdullah, and others, he sent letters of reassurance to the Egyptian people about the existence of a solution to pump the needs of the market of foreign currency to end the shortage of medicines. Or psychologically for the patient.
He said: « The medicines that suffer from the shortage, some of them are sugar drugs and other drugs tumors and drugs of the glands and heart, drugs related to chronic diseases, which is now being secured, and we as factories work with a stock of raw materials enough for 4-6 months, and this stock reached only weeks, and therefore we are now in the stage of risk, and therefore the government began to move ».
He added that the health sector is supported by the provision of foreign exchange resources to provide all needs according to a plan to deal with such circumstances, stressing the importance of full coordination between the unified purchasing authority and the pharmaceutical industry room as well as pharmaceutical companies to face any problems related to the shortage of supplies, medicines and medical consumables.
As well as a detailed presentation on the commitments implemented and not implemented in the period from June 2023 to January 2024, with regard to the provision of (medicines, medical supplies, laboratory supplies, devices, raw materials and packing materials), and the Minister was briefed on the results of the mechanisms established with the Central Bank of Egypt to pay the obligations in foreign currency to meet the demands of the health care sector.
In the end, the official spokesman stressed that the shortage of drugs does not exceed 15% and the drugs directed to tumors are at the forefront of the shortcomings because of their close link to the currency and what faces the supply chains, otherwise all drugs and within them are compatible... The complaints are due in their entirety to the lack of knowledge of citizens with the trade names of medicines.
In addition to the above, a severe shortage of anesthetic drugs, dental pening drugs, nephrology and recovery drugs, which will cause a real disaster that threatens the conduct of surgical operations for patients, and thus increase the waiting lists in hospitals and the occurrence of complications for patients that may result in loss of their lives.
The head of the medicine division of the Federation of Chambers of Commerce, Ali Ouf, revealed that a request will be submitted to the Egyptian Drug Authority early next week to move the prices of 1,500 items in light of what he described as developments in the situation and rising costs.
He pointed out that « the need to raise the wages of workers in the pharmaceutical sector to compensate them for the cost of living and therefore must raise salaries so that they can live in the current conditions and the sector will bear the increase of salaries at the expense of cost and raise the minimum insurance ».
On the shortage of medicines, Amin al-Dabraki, one of the dealers in the pharmaceutical market, said that the main reason for the crisis is the lack of active substances imported by companies.
This is mainly due to the dollar crisis, in addition to the withdrawal of some financial companies from the Egyptian pharmaceutical market.
On the inability of the Ministry of Health to move the prices of medicines with the movement of the exchange rate, he said that the solutions are the intervention of the state by providing a fixed customs dollar for pharmaceutical companies, while moving the prices of medicines, in addition to starting factories to produce active substances inside Egypt.

Smuggling brokers exploited price differences by diverting Egyptian medicines abroad, particularly to conflict areas, where they were sold at exorbitant prices.

A shortage of hard currency in Egypt further exacerbated the disappearance of medicines from the local market, as pharmaceutical companies struggled to import active substances.

In the United States, the relocation of drug production to countries like China and India was identified as a contributing factor to supply chain vulnerabilities.

Increased demand due to a high prevalence of respiratory diseases, coupled with insufficient production capacity, also played a role in exacerbating shortages.

A study in Spain revealed a 38% increase in drug shortages over the past year, driven by inflation, high energy costs, raw material shortages, and lingering pandemic-related impacts.

The pandemic further strained pharmaceutical manufacturers, with high energy prices reducing company profits and limiting production capacity.

Countries failed to anticipate the surge in respiratory infections during the first year without widespread mask usage, leading to increased demand for medications.

In the United States, fragmentation in the drug supply chain was identified as a major contributor to recurring shortages.

The impact of these shortages on patients and healthcare systems was profound, with more than half of treatment gaps lasting over two years and affecting at least half a million patients, many of whom were elderly.

In Egypt, the shortage of vital medications, including stents, heart drugs, diabetes treatments, and tumor therapies, exacerbated patient suffering in public hospitals.

A severe lack of anesthetic drugs, dental medications, and nephrology treatments threatened surgical operations and increased hospital waiting lists, potentially leading to life-threatening complications.

In Jordan, medication shortages posed significant health, economic, and social challenges, threatening patient safety and the overall quality of healthcare.

Title:

Content: Lack of medicines in MOH hospitals and accumulation of indebtedness Repercussions / solutions
3 hours ago
Dr. Naeem Malkawi
The problem of shortage of medicines in Jordanian hospitals requires quick and effective attention and intervention, as providing medicines to patients is one of the foundations of quality health care and one of the most important strategies of the Ministry of Health, however, the shortage of medicines in many hospitals leads to health, economic and social challenges that threaten the quality of health care and patient safety.
The budget of the Ministry of Health of medicines, vaccines, vaccines and medical consumables for this year 2023 was estimated at 103.75 million dinars, where the actual for the past year 2022 was 93.8 million dinars.
The question is, how did the Ministry of Health accumulate such a large indebtedness in the item of medicines to reach 300 million dinars for pharmaceutical companies?
And why last week was the debt of 2019 cleared and deducted estimated at 50% of the debt for that year?
This means that there is still a delay in the payment of dues for companies for the years 2020, 2021 and 2022 in addition to eight months of the current year 2023, and this brings us to a range of reasons and challenges:
1.
The aim of the Ministry of Health was to reduce the bureaucracy of procedures and overcome the complexity of procurement references in hospitals and health directorates in the governorates and not to obtain price and discount preferences, but the results indicate a defect in the management and mechanism of dealing with the strategy of unified and central procurement, despite the margin for hospital administrations to use the power of direct purchase in cases of necessity.
2.
Preparation of sub-budgets for hospitals: Evidence shows that there is a problem in the preparation of sub-budgets for hospitals and the main budget of the Ministry of Health with regard to the item of medicines, which is due to the lack of accurate and sufficient data on the number of patients and hospital needs of medicines, and the lack of accurate forecasting of future needs.
3.
Delays in the review of financial claims and invoices between the Ministry of Health and the hospitals on the one hand and the pharmaceutical companies on the other hand, is one of the most important reasons behind the accumulation of indebtedness, and this negatively affects the liquidity of the pharmaceutical companies and hinders them from providing a sustainable service in adhering to the procedures of supplying medicines according to schedule.
4.
Lack of coordination and communication: There may be a lack of coordination and communication between hospitals, the Ministry of Health and pharmaceutical companies, which complicates the supply and distribution of medicines and increases the chances of delays and the depletion of medicines from hospitals in the absence of an effective policy for stock management and the time required for stock adequacy.
5.
Focusing on the trade names of certain drugs from specific production sources and not adopting the protocol of writing the scientific name for the prescriptions of patients.
6.
One of the reasons that may be major and important at the same time is the funding aspect and the lack of the necessary allocations or use them in other aspects other than medicines to fill a deficit or emergency during the use of budget items due to the scarcity of available liquidity. Medication.
Lack of medication can lead to:
1.
Threat to patient safety: Lack of medication puts sick people at risk, as this can lead to delays in receiving necessary treatment or the unavailability of vital drugs, putting their lives at risk.
2.
Economic Implications: The lack of medicines entails additional economic costs for the health system and patients.
Medical cases may be referred to other medical centers or private hospitals, increasing pressure on other MOH budget items.
3.
Pressure on health care workers: Health care workers are under pressure as a result of dealing with patients affected by drug shortages and repeatedly facing their inquiries and complaints.
4.
Social repercussions:
Increased anxiety and stress: A lack of medication can lead to an increase in anxiety and stress among patients and their families, as they live in uncertainty about the availability of the necessary treatment.
Lack of medication can affect the level of trust in the health system among citizens, who may feel that the system is unable to provide them with adequate health care.
Increased costs and social burdens: Some patients may have to incur additional costs to obtain drugs from other sources outside hospitals, affecting their financial and economic status.
After all this narrative there must be ways to overcome these dilemmas:
1.
Preparation of budgets scientifically and professionally: Hospitals should develop more accurate standards for the preparation of sub-budgets for medicines, through the analysis of previous data, estimation of future needs and other scientific and methodological foundations in the preparation of budgets and commitment to apply them accurately.
2.
Improve coordination and communication between parties: Coordination between the Ministry of Health, hospitals and pharmaceutical companies should be strengthened through the establishment of structured mechanisms for information exchange, review of invoices, and completion of claims, and not delay them.
3.
Implementation of fiscal reforms: The Government and the Ministry of Health should implement fiscal reforms that provide funding to cover this important item and pay dues in a timely manner, reduce bureaucracy in the financial audit process, and proceed with payment procedures within the timetable mechanism agreed in the tender terms.
4.
Achieving social responsibility: The government and pharmaceutical companies should adopt a social responsibility towards patients by providing these drugs and reducing their prices in the market to make them more accessible to patients while relieving part of the pressure and burden on hospitals.
Addressing the problem of drug shortages in government hospitals requires comprehensive cooperation between all concerned parties from government, Ministry of Health, hospitals, drug suppliers and patients.
To provide medicines on a permanent basis and to ensure the provision of high quality health care to the Jordanian patient.

Economic implications included increased costs for both health systems and patients, as well as referrals to private hospitals, which strained other budgetary allocations.

Healthcare workers faced heightened pressure due to patient complaints and inquiries about unavailable drugs, further straining the system.

Social repercussions included increased anxiety and stress among patients and families, reduced trust in healthcare systems, and financial burdens from sourcing medications outside hospitals.

In the United States, one in three health systems reported delaying, canceling, or rationing care due to drug shortages, often resorting to alternate medications to treat patients.

Patients undergoing chemotherapy faced uncertainty about receiving life-saving treatments, as clinicians struggled to guarantee drug availability.

Title:

Content: How the Chemotherapy Shortage Is Affecting Frontline Clinicians

— "How are we here in 2023 having some of these discussions?" bemoans gynecologic cancer expert

MedpageToday
  • Emily Hutto is an Associate Video Producer & Editor for MedPage Today. She is based in Manhattan.

In this exclusive Instagram Live clip, Jeremy Faust, MD, editor-in-chief of MedPage Today, and Eleonora Teplinsky, MD, head of Breast and Gynecologic Medical Oncology for Valley-Mount Sinai Comprehensive Cancer Center in Paramus, New Jersey, discuss how the recent shortage of the chemotherapy mainstays cisplatin and carboplatin have impacted cancer patients and frontline clinicians.

The following is a transcript of their remarks:

Faust: Dr. Teplinsky, let me ask you about your side as a frontline clinician in this area. As an ER doctor, I don't type in, "Let's give a patient cisplatin." That's not an order that I put in. So, how long have you been seeing shortages like this that affect your patients?

Teplinsky: I would say around April -- again, talking about this particular shortage with carboplatin and cisplatin -- I think around April we started hearing about it. But it was one of those things, I'll be honest, where you're like, "Oh, this can't possibly happen. This is happening somewhere else. This isn't affecting us."

Then I think NBC ran an article on it. Then for a month nothing happened, and then all of a sudden, I would say in May, it really kind of exploded in the sense that many, [the] majority of cancer centers were either experiencing complete absence of drugs or shortage of drugs. They weren't able to procure it from their suppliers.

That quickly made its way to the patients not being able to get the drug, or having to sit in front of a patient and say, "I have a treatment for you. I don't know if you'll get it. I don't know when you'll get it. I don't know what dose I can give you."

And imagine, you're already facing this life-changing diagnosis, but there are drugs -- you just don't know when you'll get them. I think that we don't talk enough about that emotional toll that takes on patients, because the uncertainty that everyone was facing was really quite tragic.

Faust: When you had that conversation with a patient -- I guess it depends on the kind of cancer, doesn't it? Because there are certain oncologic conditions where we're so fortunate that we have many, many regimens. Maybe this one is a tiny bit better than that one and you're sort of scraping out on your Kaplan-Meier curves, your survival curves, a couple of months here. Are you able to reassure your patients, or does it really depend on the kind of cancer that we're talking about?

Teplinsky: It really depends on the kind of cancer.

I will say that the Society of Gynecologic Oncology really led the way with this because, unlike in other cancers where you can substitute, in gynecologic cancers it's really hard -- you need the platinum drugs. So they led the way. And then ASCO, the American Society of Clinical Oncology, followed and came up with guidelines for clinicians about when you can substitute, what you could substitute. Can we spread out the dosing, so instead of every 3 weeks, can we give it every 4 weeks to make the drug last longer? Can you reduce the dose?

Conversations that, again -- how are we here in 2023 and having some of these discussions? But that's kind of what happened.

The challenge really was: do we have data to substitute? Will you sacrifice the efficacy if you switch from one drug to another? Then as a result, if now everyone is shifting to this drug, do we have supply for the other drugs? So I think [they really were] very difficult discussions. And again, for some disease types we were able to make that switch, but not for all.

Faust: OK. I want to jump over in just a second to some of the policy side, but let me stick with you for one moment just to pursue that point a little further.

I study outcomes, mostly with COVID, but lots of other things too. But when you're making these switches, I know that in pediatric oncology, for example, they're always tweaking and testing and saying, "Let's compare A to B and see how they do." As this is happening, is this just too chaotic for anyone to stop and say, "Well, actually this is a little bit of an unfortunate opportunity to see well, are these biosimilars actually behaving decently comparably?" Or is it just too random for anything to be learned from this?

Teplinsky: Yeah, I think that it would've been great to be able to study, but it was too erratic because everyone was at different points in their treatment cycles. Some people had gotten five cycles and they had one more left. Other people were just starting out. Some of those patients we had to pivot and not do chemotherapy first, for example, and do surgery first where we normally wouldn't. So the circumstances and the situations were each too different to actually look at this in a cohesive way.

I do think that, fortunately, people moved fairly quickly to try to get drugs and try to increase supply. So we were in this bad point for a couple weeks, but it started to recover, but now we're seeing a different shortage of 5-fluorouracil.

I am curious about this from the policy side, but unless we really come up with long-term solutions, the short-term solutions are going to just lead us to another drug shortage in 3 more months for something else.

Faust: You mentioned the word "allocation" and that set off a thought that I wanted to talk about on the clinical side. So Dr. Teplinsky, we know that drugs don't reach every community equally, right? There are certainly "haves" and "have-nots" and the in-between. From the standpoint of oncology, do we sense that when shortages happen, there's a disparity in terms of who's affected?

Teplinsky: Absolutely. I mean, I think we have to keep in mind that the majority of patients are still treated in the community setting.

For this particular shortage, NCCN, the National Comprehensive Cancer Network, did a study of multiple NCCN sites and they found that about 93% were affected by the shortage in some way. What we don't have information on, again, is in terms of exactly which settings were more affected than others.

Understandably, patients, if they are treated in a community site that maybe is not a big center -- that's a small site that purchases a very small amount and didn't stockpile -- those people are going to be predominantly affected. And very often they cannot travel to a bigger site that has more resources if they're in a setting where this is the only site or they are limited by socioeconomic disparities.

Absolutely, this heightens the already ongoing disparities that we see in cancer treatment. Absolutely.

Faust: In terms of how that plays out for your patient population or your colleagues, does this lead to your job being a lot of case management, in a sense? You know the medicine, you know the drugs, but what you need to figure out is who has what and who can go where. Is that really where a lot of resources and your time get spent in your office?

Teplinsky: I mean, that's part of it.

I think the challenge too is that, a couple months ago, no one knew when more drugs would arrive. So a lot of places were also sharing with each other, but they were also hesitant about taking on new patients, right? Because if we can't even provide for our existing patients, what's that going to look like?

But I think the other piece that really is challenging is, if you do have a limited supply, who do you prioritize it to? This was something we saw in COVID also in terms of access to care when the pandemic was at its height. The same thing now: do you give [the drugs] to the person that is going to be cured, hopefully, with this, or someone who needs it for a palliative reason? But how do you make that distinction?

I think those are really challenging questions and really hard decisions for physicians to have to make.

Faust: What do you tell a friend -- not a patient, because a patient's coming to you and you're going to treat them -- if someone says, "Look, I got a biopsy and they're sending me to this oncology center or that one," would you tell them to look into this? You don't want to go down a pathway with a wonderful practice who actually can't treat you, when across the street for reasons that we just discussed a minute ago -- some negotiation or someone got it ahead of a stampede in a panic -- they have the drug.

Would you advise patients who are looking at this landscape to behave any differently than they would've in another environment?

Teplinsky: Absolutely. I mean, I'm a firm believer that patients have to be their best advocate and you have to be your own advocate. I think it's a very appropriate question to say when you're meeting a practice, "I know that my regimen is recommended to have carboplatin," for example, "Can you talk about where your institution or cancer center or hospital is with regards to these shortages?" I think that those are very valid questions.

Part of the things that we say: what should you ask your oncologist? I think in this space and time that we're in, that should be part of the list. Because again, like you said, you don't want to all be set up for treatment to find out that they don't actually have the drug.

I think the challenge is in patients who are not able to do that, who are not able to go somewhere else, and that's really hard.

Faust: Yeah. It's interesting to me, again, I'm an ER doctor, but I work in a pretty fancy magnet hospital. People always come to us for second opinions or for the magic stuff that Dana-Farber [Cancer Institute] might have, as if it's any different.

In some cases, look, we have wonderful experts and we have some experimental treatments that are unavailable everywhere else. But a lot of times when it's straightforward, I kind of feel like we've got a nation of really, really qualified oncologists. You don't need to fly halfway across the country to get first-line treatment. And yet, some people actually would do that. They want that name brand.

But now you could argue that the big-name brands are probably the ones that have the most purchasing power and bargaining power, so all of a sudden it might matter, right?

Teplinsky: Yeah, I think we don't know. And it varies. I mean, some of the biggest cancer centers were actually the ones experiencing some of the bigger shortages.

Faust: Oh, really?

Teplinsky: It was very variable throughout the country, but you could see on Twitter, people were sharing, "Who's got the drug? Who doesn't have the drug?" So it really was very surprising, actually, that this hospital had it, this cancer center didn't, and vice versa.

It's also such a fluctuating state, right? You might have it tomorrow, you might not have it the next week, which is why I think this was so hard for patients because there was no guarantee of when it would come back. I think that really exacerbated all of it as well.

The emotional toll on cancer patients was significant, as they navigated life-changing diagnoses alongside the uncertainty of treatment access.

Smaller community healthcare sites were disproportionately affected by shortages due to limited purchasing power and the inability to stockpile medications.

Socioeconomic disparities further exacerbated the impact, as patients in underserved areas often lacked the means to travel to larger centers with better resources.

Healthcare providers faced difficult decisions about prioritizing limited drug supplies, such as allocating them to curative treatments over palliative care.

In response to these challenges, various mitigation strategies were implemented globally, including efforts to improve coordination and communication within supply chains.

The Egyptian government coordinated with pharmaceutical companies and the unified purchasing authority to secure foreign exchange resources and ensure the availability of raw materials.

The FDA in the United States issued draft guidelines requiring manufacturers to notify the agency at least six months before ceasing drug production or as soon as possible if six months' notice was not feasible.

Governments in Europe promoted the sale of generics, substituted requested medicines with similar alternatives, and modified drug formulations to address shortages.

The European Commission announced plans to revise pharmaceutical legislation to include stricter supply obligations, earlier notifications of shortages, and improved public communication about stock availability.

In Taiwan, the government launched a 'Drug Market Monitoring System' to strengthen pharmaceutical supply monitoring and enable pharmacists to quickly query inventory.

Title:

Content: Cai Ing-wen: Thanks for 8 years of support, the epidemic and the government work together
Journalist Chen Wei-uei / reporting from Taipei
President Tsai Ing-wen attended the Spring Wine Dinner of the National Federation of Pharmacists of the Republic of China (ROC) on the evening of today (25), saying that the Ministry of Health and Welfare, the Food and Drug Administration and the National Health Insurance Administration have actively responded to the shortage of drugs.
In the future, Taiwan will enter an ultra-aging society, medical treatment combined with technology will become the norm, and the government will continue to improve and amend laws and regulations in a timely manner, looking forward to improving medical services.
This is an advertisement, please continue reading.
Tsai Ing-wen said in her speech that this year, the All Federation of Pharmacists Association will soon reach its 44th anniversary, and the past presidents and supervisors are committed to fighting for the rights of pharmacists, and also let the Federation become a bridge for communication between the government and the industry, so that the government can hear the voice of the pharmaceutical industry and be closer to public opinion in policy.
She would like to thank President Huang Jinshun for his leadership over the past few years, as well as all the good friends of pharmacists to protect the health of the people of the country.
At the same time, she also wants to spend her old age, and wish everyone a happy and safe New Year.
In the past few years, in the face of the challenges of the epidemic, all pharmacists have worked hard to stand on the front line, not only to mobilize drugs, but also to help the government release masks and rapid screening tests.
Tsai Ing-wen said that in addition to going deep into the community and the Changshu Center, the Association also shares Taiwan's experience in epidemic prevention and public health with pharmaceutical organizations around the world, so that the world can see Taiwan, give full play to the spirit of "Taiwan Can Help," and contribute its own efforts to the world.
Tsai Ing-wen pointed out that the government knows that the world is facing a shortage of drugs in recent years, and has asked the Ministry of Health and Welfare, the Food and Drug Administration, and the National Health Insurance Administration to actively respond to the problem.
At present, the "Drug Market Monitoring System" has been launched. This system will strengthen the monitoring of the supply of pharmaceutical products in the middle market, so that the front-line pharmacists can query the inventory of pharmaceutical products more quickly and ensure the rights and interests of the public.
Tsai Ing-wen stressed that Taiwan's society is entering an ultra-old age, and in the case of fewer children, the medical needs for home care will continue to increase.
In the future, medical combined technology will become the norm, such as telemedicine services and smart medical services that have been opened up.
The government will also continue to improve and amend regulations in a timely manner to ensure information security and patient privacy, and improve medical services.
Finally, Tsai thanked everyone for their support during her eight-year term in office, which allowed Taiwan to “pass through and overcome the barriers. ”
During the 100-year pandemic, I would like to thank my friends and the government for their hard work, so that Taiwan's epidemic prevention performance has been recognized by the world, and so that the public can better understand the role of pharmacists in the national epidemic prevention and medical system.
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The FDA temporarily allowed overseas manufacturers to import chemotherapy drugs like cisplatin to address critical shortages in the United States.

Cancer hospitals adjusted by ensuring sufficient medication for ongoing treatment courses and modifying regimens for new patients starting chemotherapy.

Pharmacists managed shortages by offering therapeutic alternatives, purchasing different vial sizes or concentrations, and rationing medicines to extend supplies.

The White House proposed a budget of $3.26 billion to $5.11 billion over the next decade to address drug shortages, pending Congressional approval.

Policymakers suggested increasing the price of generic drugs to attract more manufacturers as part of a long-term solution to drug shortages.

Recommendations also included granting the FDA greater authority to access information about drug shortages and requiring manufacturers to be transparent about supply chain issues.

The American Society of Health System Pharmacists advised the federal government on measures such as diversifying supply chains and increasing transparency to mitigate future shortages.