Global medication shortages have reached unprecedented levels, with a record high of 323 drugs in severe shortage in the first quarter of 2024, surpassing the previous peak of 320 in 2014.

These shortages have significantly impacted critical drug categories, including sterile injectable generic drugs such as cancer chemotherapy agents and emergency medications used in hospitals.

The five most affected drug categories include central nervous system stimulants, antimicrobials, hormonal agents, intravenous fluids, and chemotherapy drugs, which are essential for treating life-threatening conditions.

In the United States, the shortage of medications increased by 30% in 2022 compared to 2021, with the average duration of shortages lasting 18 months and some persisting for up to 15 years.

By the end of 2022, nearly 300 pharmaceutical products were affected by shortages in the United States, marking a five-year peak.

In France, the number of reported drug shortages rose sharply from 2,160 in 2021 to 4,925 in 2023, highlighting the global nature of the crisis.

A 2024 survey in France revealed that 44% of respondents had experienced a drug shortage, underscoring the widespread impact on patients.

In developing countries like Egypt, shortages of vital medications such as insulin, tumor treatments, and anesthesia have exacerbated the suffering of patients, particularly in public hospitals reliant on subsidized medicines.

The shortage of essential drugs, including those for chronic diseases, heart conditions, and nephrology, has led to delays in treatments and increased hospital waiting lists.

The root causes of these shortages are multifaceted, including growing demand, manufacturing and quality issues, supply chain disruptions, and economic factors.

A significant contributor to the crisis is the global fragmentation of the drug supply chain, which has been a persistent issue since 2021.

Economic vulnerabilities, such as the reliance on foreign production in countries like India and China, have made the supply chain susceptible to natural disasters and political instability.

In Egypt, the importation of 95% of raw materials in foreign currency has compounded the crisis, particularly due to a shortage of hard currency.

The closure of manufacturing facilities, such as a factory in India following FDA inspections, has also disrupted the supply of critical generic drugs.

Specific drugs affected by shortages include diabetes medications like Ozempic and Mounjaro, adrenaline for allergy treatment, amoxicillin for children, and chemotherapy drugs.

In Ireland, a paracetamol shortage during the winter flu season highlighted the vulnerability of even common over-the-counter medications to supply chain disruptions.

In Egypt, the shortage of streptokinase, a critical drug for treating heart and lung strokes, has left patients in remote areas without life-saving alternatives.

Healthcare systems have adopted various coping mechanisms, such as switching patients to therapeutic alternatives and placing large proactive orders to mitigate the impact of shortages.

However, these measures have sometimes added stress to the system, as large orders can exacerbate supply chain bottlenecks.

In some cases, healthcare providers have been forced to ration treatments, prioritizing certain patients over others due to limited drug availability.

Economic and social implications of medication shortages include increased healthcare costs, financial burdens on patients, and heightened anxiety among families.

In Egypt, smuggling of medicines to neighboring conflict zones has further exacerbated local shortages, with organized gangs exploiting price differences for profit.

Efforts to improve transparency and coordination include FDA guidelines requiring manufacturers to notify disruptions in drug production and maintain safety stocks.

The European Commission has proposed reforms to the pharmaceutical industry, including incentives for innovation and measures to limit antibiotic overuse.

In Egypt, the government has implemented a system to redistribute medicines between hospitals based on need and consumption rates.

Policy recommendations include granting regulatory bodies like the FDA more authority to access supply chain information and mandating transparency from manufacturers.

The White House has proposed a multi-billion-dollar investment over the next decade to address drug shortages, pending congressional approval.

In France, advocacy groups have called for public cost evaluations to justify price increases and prevent pharmaceutical companies from abandoning less profitable drugs.

Long-term solutions to medication shortages will require a multi-stakeholder approach, including fiscal reforms, improved forecasting, and enhanced coordination between governments and pharmaceutical companies.

Global medication shortages have reached unprecedented levels, with a record high of 323 drugs in severe shortage in the first quarter of 2024, surpassing the previous peak of 320 in 2014.

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Content: General Supervision
Elham Aboul Fath
Editor-in-Chief
Thank you for your patience.
General Supervision
Elham Aboul Fath
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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

These shortages have significantly impacted critical drug categories, including sterile injectable generic drugs such as cancer chemotherapy agents and emergency medications used in hospitals.

The five most affected drug categories include central nervous system stimulants, antimicrobials, hormonal agents, intravenous fluids, and chemotherapy drugs, which are essential for treating life-threatening conditions.

In the United States, the shortage of medications increased by 30% in 2022 compared to 2021, with the average duration of shortages lasting 18 months and some persisting for up to 15 years.

Title:

Content: The New York Times Original
Continue reading Growing drug shortage in the United States has become a threat to national security
The shortage of medicines in the United States last year increased compared to 2021 by 30%, according to The New York Times.
However, the article notes that the growing shortage of inexpensive but critical drugs poses a national security threat to the United States.
The growing shortage of inexpensive but critical drugs poses a threat to U.S. national security and forces hospitals to make “terrible ” choices, writes The New York Times, citing a report prepared for hearings in the U.S. Senate.
According to this report, the shortage of medicines last year increased by almost 30% compared to 2021, with an average shortage of medicines observed for 18 months, and for some drugs – 15 years.
Among the drugs in short supply are conventional antibiotics and anesthetics, the article said.
Senator Gary Peters, a Democrat from Michigan and chairman of the Senate Committee on Homeland Security and Government Affairs, said that these problems are related to economic factors, an opaque supply chain and the fact that 80% to 90% of some products are made abroad.
“Taken together, these underlying causes not only raise serious concerns about ensuring proper patient care, but also pose a serious threat to national security, ” Peters said.
Dr. Andrew Schumann, an oncology surgeon from Michigan, told senators at the hearing that the shortage of drugs in his field is "a tragedy occurring in slow motion."
As Schumann noted, recently due to the shortage of one cheap, but well-proven cancer drug, he had to choose which patients will receive this drug.
The article notes that many of the cheapest drugs tend to be made in countries such as India and China, where they are inexpensive to manufacture.
However, this concentration of production capacity creates an additional level of vulnerability to problems such as natural disasters and political unrest, emphasizes The New York Times.
The materials of InoTV contain estimates of exclusively foreign media and do not reflect the position of RT
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By the end of 2022, nearly 300 pharmaceutical products were affected by shortages in the United States, marking a five-year peak.

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 France, the number of reported drug shortages rose sharply from 2,160 in 2021 to 4,925 in 2023, highlighting the global nature of the crisis.

Title:

Content: French health groups put forward proposals to limit the damage of worsening drug shortages

Medicines such as cough syrup, lozenges and ointment are seen on a table in an apartment in Berlin, Tuesday, December 20, 2022. Copyright Stephanie Pilick/dpa via AP
Copyright Stephanie Pilick/dpa via AP
By Lauren Chadwick
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Pharmaceutical companies’ lack of transparency leads to rising drug prices and less control over public resources, the group of health organisations say.

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A group of French organisations have called for more transparency from pharmaceutical companies as drug shortages increase.

In a joint report, 14 civil society organisations outlined their recommendations to solve a “situation that has only worsened” since 2018.

The French medicines regulator signalled 4,925 drug shortages in 2023, compared to 3,761 in 2022 and 2,160 in 2021.

A 2024 survey from France Assos Santé, which represents patients, found that 44 per cent of people in France said they had faced a drug shortage this year.

One of the pharmacy unions in France has even planned a strike at the end of the month over drug shortages and what they say is worsening access to care.

Each health organisation contributed an article with recommendations for dealing with the drug shortages.

The League Against Cancer urged complete transparency on drug shortages and potential substitutions for health professionals.

They also called for monitoring of medicine stocks and their location in the country to guarantee equal access.

The organisation found in a survey published in February that 78 per cent of health professionals in oncology had been faced with a drug shortage.

Drug shortages or delays have led to anxiety among cancer patients, lost time, and worsening symptoms, the organisation said.

France Assos Santé, meanwhile, wrote that an urgent response should not be to support “the industrial sector which bears serious responsibilities” for abandoning the production of less profitable drugs, relocating drug production, and keeping insufficient medicine stocks.

They would like any cost increases justified by production costs or the risk of withdrawing a drug from the market due to it being unprofitable. They called for cost evaluations to be made public.

Their concerns also range from the use of public money to bring drug production to Europe to new government plans to prevent shortages.

Some changes at the EU level criticised

Last year, the European Commission announced several measures to reform the pharmaceutical industry and address critical drug shortages.

The European Parliament went on to adopt a position on pharmaceutical reform last month, that included “incentives for innovation” and an effort to limit overuse of antibiotics.

The non-profit organisation Prescrire, which focuses on information about medicine, wrote in a chapter they contributed to the report that while some of the European Commission’s measures were welcome, others were concerning.

One of the many measures they rejected included the Commission’s proposal to reduce the number of days of scientific evaluation of drugs from 210 to 180, which they said was necessary time rather than an “administrative obstacle”.

While the NGO welcomed some measures such as government drug shortage prevention plans, it said the Commission should allow EU states to require pharmaceutical companies to have safety stocks of medicine and sanction those that do not respect them.

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French consumer organisation UFC-Que Choisir and the European Consumer Organisation (BEUC) said that they had hoped MEPs would shorten the length of time for “data protection” to allow generic medicines to be marketed more quickly.

Instead, MEPs approved shortening the period to 7.5 years, “which is almost the same duration as the current 8 years [yet] within the framework of the text adopted by Parliament, companies can gain additional months of protection under certain conditions to reach a total of 8.5 years,” UFC-Que Choisir said.

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A 2024 survey in France revealed that 44% of respondents had experienced a drug shortage, underscoring the widespread impact on patients.

In developing countries like Egypt, shortages of vital medications such as insulin, tumor treatments, and anesthesia have exacerbated the suffering of patients, particularly in public hospitals reliant on subsidized medicines.

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Content: Chairman of Wafd Party
Dr. Abdul Sindh Yamama
Chairman of the Board of Directors
Dr. Ayman is an accountant.
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My grandfather, Zainuddin.
Chairman of Wafd Party
Dr. Abdul Sindh Yamama
Chairman of the Board of Directors
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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.

The shortage of essential drugs, including those for chronic diseases, heart conditions, and nephrology, has led to delays in treatments and increased hospital waiting lists.

The root causes of these shortages are multifaceted, including growing demand, manufacturing and quality issues, supply chain disruptions, and economic factors.

A significant contributor to the crisis is the global fragmentation of the drug supply chain, which has been a persistent issue since 2021.

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. ”

Economic vulnerabilities, such as the reliance on foreign production in countries like India and China, have made the supply chain susceptible to natural disasters and political instability.

In Egypt, the importation of 95% of raw materials in foreign currency has compounded the crisis, particularly due to a shortage of hard currency.

The closure of manufacturing facilities, such as a factory in India following FDA inspections, has also disrupted the supply of critical generic drugs.

Specific drugs affected by shortages include diabetes medications like Ozempic and Mounjaro, adrenaline for allergy treatment, amoxicillin for children, and chemotherapy drugs.

In Ireland, a paracetamol shortage during the winter flu season highlighted the vulnerability of even common over-the-counter medications to supply chain disruptions.

Title:

Content: Ireland has been suffering a paracetamol shortage as cases of Covid-19 and the winter flu in the country soared over the festive and new year period.

The revelation was made by Health Minister Stephen Donnelly after his department received notification of a supply issue from the Health Products Regulatory Authority.

It is understood the shortage impacted some prescription paracetamol products.

Read More:Irish people complain of ‘worst ever’ winter bug sweeping country that feels like Covid but isn’t

Two suppliers affected have stated that resupply will be sometime in January 2023.

However, there are other prescription paracetamol suppliers with some stock available on the shelves.

Paracetamol is one of the medicines used most often in Ireland and especially for the flu, aches and pain.

But Mr Donnelly pointed out that there are multiple forms of the drug with different strengths and brands available from various sources.

He said: "In the event that there are some supply issues for individual medicines, alternative options such as alternative strengths and brands, generic medicines will usually be available to ensure continuity of treatment.

"In some cases where the medicine initially prescribed for the patient is unavailable, patients may be switched to a suitable therapeutic alternative following appropriate consultation with a healthcare professional."

The Health Minister said medicine shortages have been increasingly prevalent worldwide over the past decade. The causes of such shortages are multifactorial including shortage of raw materials, manufacturing difficulties and industry consolidations.

He stated: "Medicine shortages can originate at any point in the supply chain. They can involve and impact many stakeholders in different ways as the supply models and clinical use of therapies can vary across national health systems.

"Management of medicines shortages necessitates a multi-faceted, multi stakeholder response to ensure patient safety , continuity of care and protection of public health.

"Patients or their carers who have any concerns in relation to temporary alternative products provided because of medical shortages are advised to speak with their pharmacist or other healthcare [professionals] involved in their care."

Mr Donnelly was responding to a number of written Dail questions on the shortage of medicines.

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In Egypt, the shortage of streptokinase, a critical drug for treating heart and lung strokes, has left patients in remote areas without life-saving alternatives.

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Content: Chairman of the Board of Directors and Editors
Mohamad Elbaz
Chairman of the Board of Directors and Editors
Mohamad Elbaz
"Health of the Elders" recommends the provision of injections for the treatment of acute thrombosis in the hospitals of the Republic
The Senate Health and Population Committee held a meeting on Monday under the chairmanship of MP Dr. Ali Mehran, Chairman of the Committee, in the presence of MP Dr. Amr Hijab, Undersecretary of the Committee, and Dr. Osama Fahem, Secretary of the Committee, to discuss the proposal submitted by MP Mu ’ min Moath, on "provision of acute thrombosis treatment injections", in the presence of government representatives.
MP Mu ’ min Mu ’ ath, the proponent of the proposal, said that the injection of acute thromboembolism such as cardiac and pulmonary (streptokinase) has a severe shortage in the Egyptian pharmaceutical market, at the governmental and private levels, and is not available in some regions, due to its extreme importance and necessary for the treatment of heart and lung strokes, especially that there is no alternative for saving patients ’ lives. As soon as possible, especially in remote provinces such as the New Valley Governorate.
Demand to support the availability of pharmaceutical needs of the medical sector
MP Mu ’ min Muath called for the need to provide injections to dissolve acute thromboembolism such as cardiac and pulmonary (streptokinase) in all hospitals, especially in remote provinces.
Dr. Rasha Al-Sharqawi, head of the Central Medical Department of Pharmacy, explained that the Ministry of Health and Population seeks to support the availability of pharmaceutical needs of the medical sector and the provision of pharmaceutical services within health facilities through the Central Department of Pharmaceutical Affairs.
Al-Sharqawi stressed that regarding the shortage of some medicines, especially chronic medicines, full and effective communication is made with all concerned parties, especially the Egyptian Unified Procurement Authority and the Egyptian Drug Authority to provide pharmaceuticals in the Egyptian market; to ensure the continuity of the availability of medicines to the Egyptian patient. All parties concerned with the availability of pharmaceuticals.
6 supply orders since January
The head of the Central Medical Department of Pharmacy confirmed that the category of medicine for the treatment of acute heart thromboembolism (streptokinase vial) has been registered for the category through the electronic platform of the Egyptian Authority for Unified Purchase with 6 supply requests since January 2024 until April 30, 2024. Since 20 / 2 / 2024 until 21 / 5 / 2024, four times have been allowed.
In the same context, Dr. Rasha Ziadeh, Assistant Chairman of the Drug Authority for Technical Development and Capacity Development, said that exceptional import approvals are made to solve the global problem related to the shortage of some pharmaceutical items and we are working to overcome the current problem until there is availability in the items. A new system that allows the transfer of medicine from one hospital to another and from one province to another according to the need and consumption rate.
At the end of the meeting, the committee recommended the need to provide and distribute the drug streptokinase to various hospitals nationwide, set a mechanism and specific criteria for its distribution according to need, and speed the provision of alternative drugs and work to localize the manufacture of these drugs in Egypt.

Healthcare systems have adopted various coping mechanisms, such as switching patients to therapeutic alternatives and placing large proactive orders to mitigate the impact of shortages.

However, these measures have sometimes added stress to the system, as large orders can exacerbate supply chain bottlenecks.

In some cases, healthcare providers have been forced to ration treatments, prioritizing certain patients over others due to limited drug availability.

Economic and social implications of medication shortages include increased healthcare costs, financial burdens on patients, and heightened anxiety among families.

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.

In Egypt, smuggling of medicines to neighboring conflict zones has further exacerbated local shortages, with organized gangs exploiting price differences for profit.

Efforts to improve transparency and coordination include FDA guidelines requiring manufacturers to notify disruptions in drug production and maintain safety stocks.

The European Commission has proposed reforms to the pharmaceutical industry, including incentives for innovation and measures to limit antibiotic overuse.

In Egypt, the government has implemented a system to redistribute medicines between hospitals based on need and consumption rates.

Policy recommendations include granting regulatory bodies like the FDA more authority to access supply chain information and mandating transparency from manufacturers.

The White House has proposed a multi-billion-dollar investment over the next decade to address drug shortages, pending congressional approval.

In France, advocacy groups have called for public cost evaluations to justify price increases and prevent pharmaceutical companies from abandoning less profitable drugs.

Long-term solutions to medication shortages will require a multi-stakeholder approach, including fiscal reforms, improved forecasting, and enhanced coordination between governments and pharmaceutical companies.


Global medication shortages have reached alarming levels, with the U.S. reporting a record high of 323 drug shortages in early 2024, including critical chemotherapy and emergency drugs.

In Europe, shortages of antibiotics like amoxicillin and pediatric medications have been widespread, while developing countries like Egypt face deficits in essential drugs such as insulin and tumor treatments.

The causes of these shortages are multifaceted, including manufacturing delays, supply chain fragmentation, and increased demand due to surges in respiratory diseases and other conditions.

In Egypt, reliance on imported raw materials, smuggling to conflict zones, and a hard currency shortage have further exacerbated the crisis.

Patients have faced significant impacts, such as delays in life-saving chemotherapy treatments, increased surgical waiting lists, and heightened anxiety due to uncertainty about drug availability.

Healthcare systems have been forced to ration care, switch to alternative drugs, and refer patients to private hospitals, increasing costs and straining resources.

Authorities have implemented various mitigation strategies, such as the FDA allowing temporary imports of chemotherapy drugs and the European Commission revising pharmaceutical legislation to improve supply chain transparency.

In Egypt, the government has coordinated with pharmaceutical companies to secure foreign exchange resources and ensure the availability of raw materials.

Long-term solutions proposed include diversifying supply chains, increasing the price of generic drugs to attract manufacturers, and granting regulatory bodies more authority to monitor shortages.

These measures aim to address the systemic issues underlying medication shortages and prevent future crises, ensuring equitable access to essential drugs globally.

Global medication shortages have reached alarming levels, with the U.S. reporting a record high of 323 drug shortages in early 2024, including critical chemotherapy and emergency drugs.

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Content: General Supervision
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General Supervision
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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.
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In Europe, shortages of antibiotics like amoxicillin and pediatric medications have been widespread, while developing countries like Egypt face deficits in essential drugs such as insulin and tumor treatments.

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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The causes of these shortages are multifaceted, including manufacturing delays, supply chain fragmentation, and increased demand due to surges in respiratory diseases and other conditions.

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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. ”

In Egypt, reliance on imported raw materials, smuggling to conflict zones, and a hard currency shortage have further exacerbated the crisis.

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Content: Chairman of Wafd Party
Dr. Abdul Sindh Yamama
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Dr. Ayman is an accountant.
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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.

Patients have faced significant impacts, such as delays in life-saving chemotherapy treatments, increased surgical waiting lists, and heightened anxiety due to uncertainty about 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.

Healthcare systems have been forced to ration care, switch to alternative drugs, and refer patients to private hospitals, increasing costs and straining resources.

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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

Authorities have implemented various mitigation strategies, such as the FDA allowing temporary imports of chemotherapy drugs and the European Commission revising pharmaceutical legislation to improve supply chain transparency.

In Egypt, the government has coordinated with pharmaceutical companies to secure foreign exchange resources and ensure the availability of raw materials.

Long-term solutions proposed include diversifying supply chains, increasing the price of generic drugs to attract manufacturers, and granting regulatory bodies more authority to monitor shortages.

These measures aim to address the systemic issues underlying medication shortages and prevent future crises, ensuring equitable access to essential drugs globally.