Between 2021 and 2024, medicine and medical supply shortages disrupted patient care worldwide, driven by supply chain gaps, demand spikes, and manufacturing or quality problems. [11].

In the United States, a record 323 active drug shortages were reported in the first quarter of 2024, with more than half of shortages lasting over two years and the average shortage affecting at least half a million patients.

U.S. shortages included diabetes drugs Ozempic and Mounjaro and dozens of chemotherapy agents, with demand surges (e.g., for Mounjaro and Zepbound) compounding a fragmented, opaque supply chain.

Cancer care was directly affected, with more than a dozen cancer drugs in shortage, 93% of academic centers reporting carboplatin shortages, and hospitals delaying or rationing care.

The FDA cited manufacturing and quality problems plus supply chain downtime as root causes of most shortages, and high demand worsened some categories such as chemotherapy.

Regulatory constraints also contributed, as DEA opioid quota cuts from 164 million grams in 2013 to 54 million in 2023 led to delays and uncertainty for patients needing controlled medicines.

During the 2022–2023 iohexol contrast media shortage, COVID-19 shutdowns reduced production, forcing hospitals to activate incident command centers, delay exams, repackage or substitute contrast, and spurring calls to diversify and localize manufacturing.

The FDA responded to oncology shortages by permitting temporary imports of some chemotherapy drugs such as cisplatin, while federal policymakers proposed $3.26–5.11 billion to strengthen supply resilience and urged greater manufacturer transparency and FDA authority. [22].

Pandemic-related supply disruptions also affected ADHD medications like Adderall, with manufacturers reluctant to fully disclose causes and capacity limits prolonging shortages.

In France, the medicines regulator signaled 4,925 shortages in 2023 (up from 3,761 in 2022), 44% of people reported facing a shortage in 2024, and 78% of oncology professionals experienced shortages, prompting pharmacy union strike plans and policy debate over transparency and reform.

French and EU responses included proposals for stricter supply obligations, earlier shortage notifications, requiring safety stocks, and shortening scientific evaluation timelines from 210 to 180 days to improve availability. [3].

Across the EU, governments also mitigated shortages by substituting similar medicines, changing formulations (e.g., pediatric syrups when tablets were scarce), and encouraging the sale of generics.

The EU discussed a solidarity mechanism to share medicines, created early warning for scarce drugs, allowed shelf-life extensions in emergencies, promoted joint procurement from 2024, and examined funding for domestic production to reduce reliance on imported ingredients.

Estonia’s shortages rose from 183 in 2021 to 450 in 2023 due to demand surges and active ingredient scarcity, affecting hospitals and patients; authorities extended discounts to some alternatives to maintain access.

Ireland faced a nationwide paracetamol shortage during concurrent COVID-19 and flu waves in 2023, with resupply expected from two suppliers while pharmacies maintained continuity through alternative strengths and generic substitutions.

India experienced recurring anti-TB drug shortages that disrupted treatment, increased the risk of drug-resistant TB, and imposed out-of-pocket burdens and repeated clinic visits on patients, prompting activists to call for transparent accounting and emergency procurement.

In Egypt, an insulin shortage threatened lives as prices jumped from 62 to 192 pounds, with high exchange rates raising raw material costs, leaks to the black market, and calls for legislation, local manufacturing, and stockpiling to protect patients.

Jordan’s public hospitals reported shortages tied to delayed payments and accumulated debts to suppliers, weak coordination, and inaccurate forecasting, which strained patient safety and budgets and led to calls for fiscal reforms and better planning.

Saudi Arabia received 107,246 shortage reports in Q1 2021—roughly 50 per hour—and an operations room resolved 98.95% of medicine shortage complaints and 99.34% of vaccination shortage complaints that quarter.

China strengthened its national shortage management in 2023 by improving a four-level classification system, enabling temporary imports of urgent drugs, enhancing production and pricing monitoring, and prioritizing rural facilities through a daily dispatch and supply coordination system. [9].

The World Health Organization warned in November 2021 of a global shortage of up to 2 billion injection devices due to massive COVID-19 vaccination demand, threatening vaccination campaigns unless supplies stabilized.

WHO and partners also addressed critical medical supply gaps by launching the COVID-19 Oxygen Response Task Force to link countries with financing and support oxygen procurement in low-income settings.

To build longer-term resilience, the WHO established an mRNA Technology Transfer Centre in South Africa and backed additional sites (e.g., Kenya) to expand local vaccine manufacturing capacity and reduce dependence on strained global supply chains.

In the United States, shortages rose 30% in 2022, with sterile injectable generics, conventional antibiotics, and anesthetics often affected, and policymakers linked the heavy reliance on offshore production to national security risks and patient harm.

Hospital pharmacists reported near-record shortages, with 309 drugs in shortage and one in three health systems delaying, canceling, or rationing care, underscoring sustained patient-level impacts.

At the system level, authorities and providers coped through emergency imports, therapeutic substitution, rationing protocols, early-warning mechanisms, joint procurement, and proposals for transparency, safety stocks, and diversified or reshored manufacturing. [22][8][28].

These cases show how manufacturing disruptions, sudden demand surges, and opaque or fragile supply chains translated into delayed treatment, forced substitutions, higher prices, and anxiety for patients—and how regulators and health systems responded with both immediate mitigations and structural reforms. [1][3][21].

Between 2021 and 2024, medicine and medical supply shortages disrupted patient care worldwide, driven by supply chain gaps, demand spikes, and manufacturing or quality problems. [11].

Title:

Content: General Supervision
Elham Aboul Fath
Editor-in-Chief
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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

In the United States, a record 323 active drug shortages were reported in the first quarter of 2024, with more than half of shortages lasting over two years and the average shortage affecting at least half a million patients.

U.S. shortages included diabetes drugs Ozempic and Mounjaro and dozens of chemotherapy agents, with demand surges (e.g., for Mounjaro and Zepbound) compounding a fragmented, opaque supply chain.

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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. ”

Cancer care was directly affected, with more than a dozen cancer drugs in shortage, 93% of academic centers reporting carboplatin shortages, and hospitals delaying or rationing care.

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

The FDA cited manufacturing and quality problems plus supply chain downtime as root causes of most shortages, and high demand worsened some categories such as chemotherapy.

Regulatory constraints also contributed, as DEA opioid quota cuts from 164 million grams in 2013 to 54 million in 2023 led to delays and uncertainty for patients needing controlled medicines.

Title:

Content: Drastic cutbacks in the supply of prescription opioids, tougher monitoring of where those pills go and other efforts to curb abuse have had an unintended consequence, Long Island doctors and pharmacists say: People who have a legitimate need for the medicine to relieve severe pain now often have a hard time finding it.

Patients say the shortage means they must endure more pain after they run out of medication. Physicians' staffs sometimes have to call pharmacy after pharmacy to fill patients' prescriptions.

“I have a dozen messages every day from people saying their pharmacy doesn’t have” opioids, said Dr. Edward Rubin, a pain management specialist with offices in Garden City and Lake Success, who said he is careful to prescribe opioids only to patients without good alternatives, particularly those recovering from major surgery.

The opioid medicine shortage that doctors and pharmacists say has emerged over the past few years comes after decades during which pain pills like OxyContin flooded the market and addicted countless Americans. Prescription-drug overdose deaths spiked in the late 1990s and early 2000s.

WHAT TO KNOW

  • Doctors and pharmacists said efforts to reduce the supply of legal opioids to prevent diversion and abuse have gone too far and made it difficult for those with legitimate pain needs to access their medicine.
  • The Drug Enforcement Administration has drastically reduced its annual caps on opioid manufacturing, leading to shortages at pharmacies, which receive a limited number of opioids each month, doctors and pharmacists say.
  • Doctors say opioids were overprescribed in the past, and they are cautious in deciding whether to authorize them for patients. But they said opioids remain the best alternative for some people with severe pain.

Although fentanyl, much of it illegally manufactured, now kills a far greater percentage of people, the number of prescription-drug overdose fatalities in 2021 — 16,706 — is only slightly below the 2017 peak and five times more than in 1999, according to Centers for Disease Control and Prevention data. On Long Island in 2022, more than 700 people died of overdoses of legal and illegal opioids, most of them from fentanyl, Nassau and Suffolk officials said this week.

Rubin and other doctors and pharmacists put principal blame for the opioid shortage on the Drug Enforcement Administration’s declining cap on the amount of opioids pharmaceutical manufacturers can produce each year. For example, the DEA slashed the quota for the most widely produced opioid, oxycodone, which includes the brand names OxyContin and Percocet, from 164 million grams in 2013 to about 54 million in 2023.

“Continuing to throttle the legitimate supply is only hurting legitimate patients at the moment,” Rubin said.

Patients who can’t find their prescribed medicine "are scrambling and switching medications, and we’re adding more risk … [because] I don't know how they're going to respond to a totally different medication," he said.

Tom D’Angelo, owner of pharmacies in Franklin Square, Garden City and Point Lookout and former president of the Pharmacists Society of the State of New York, said the DEA should increase quotas so patients with legitimate pain needs can obtain relief.

He fears that some people in severe pain may resort to buying pills on the street, where something sold as oxycodone may actually be a potentially fatal dose of fentanyl.

“If you’re in enough pain, you’ll try anything,” he said.

Rationing pain-relief pills

John Douglas, 66, of Lake Grove, has been taking opioid medications for several years, first for neck pain, and now also for joint pain from prostate cancer drugs.

“I’m in pain constantly,” he said.

He’s tried several alternatives to opioids and, although the hydrocodone he takes “doesn’t give me 100% relief,” it reduces pain and allows him to work as a physical therapist assistant.

Yet, multiple times, he’s faced delays or uncertainty in obtaining medication, and he’s had to cut pills in half to ration them, which increases his pain.

“I’m sick and tired of every time you go to the drugstore, you don’t know if your medicine is going to be there or not,” he said. “It’s just not right.”

People with legitimate pain are being “penalized” for those who abuse opioids, he said.

Patients nationwide have struggled to obtain their opioid medications. Hundreds of chronic pain patients, medical professionals and others submitted remarks to the DEA last year about the agency's 2023 quotas, some expressing concern that decreases “have resulted in a shortage of opioid medications, interfered with the treatment of patients, and impacted the quality of life for patients possibly leading to suicide,” according to a DEA summary of comments released in December.

Critics, in comments submitted to the DEA and in statements from pharmaceutical executives and others, said DEA quotas on ingredients for attention deficit/hyperactivity disorder medications also are among the reasons for a nationwide shortage of those drugs.

But faced with an ongoing opioid crisis, the DEA has been under pressure to reduce quotas. A 2020 letter to the DEA from Senate Judiciary Committee Chairman Dick Durbin (D-Ill.) and Sen. John Kennedy (R-La.) said despite huge previous cuts in quotas, they were still “excessively high.” Spokespeople for Durbin and Kennedy did not respond to requests for comment.

The DEA in the December report said its quotas are set “in a manner to provide for all legitimate medical purposes.” It also said the limits "help prevent the misuse and diversion of pharmaceutical controlled substances,” and overdoses. A DEA spokeswoman declined to comment further.

The DEA acknowledged in the report that fewer than 1% of five common opioid medications were diverted for illicit uses. Numerous comments also pointed out that despite the drop in quotas, overdose deaths were up — especially from fentanyl and pain pills manufactured illegally outside the quotas.

Mary Silberstein, senior director of strategic alliances and special projects for Hicksville-based CN Guidance and Counseling Services, said restrictions on opioid supply and distribution were “much needed” and have saved lives.

“When you had so many people giving out the prescriptions in such large quantities, you had to have restrictions,” she said.

Silberstein said even though most people with opioid problems currently coming to CN Guidance are misusing fentanyl, a significant number are addicted to prescription opioids.

Opioid prescription rates drop on Long Island

The massive decrease in opioid quotas came after dramatic increases in the 1990s and 2000s. The quota for oxycodone, for example, rose from 3.5 million in 1993, before FDA approval of one of the most widely abused opioids, OxyContin, to its peak of 164 million in 2013. Other opioids had less extreme increases or were taken off the market.

Although the number of opioid prescriptions began falling after 2010, there still were about three times as many opioids prescribed in 2015 as in 1999, when calculated by “morphine milligram equivalents,” to account for differences in drug type and strength, according to a 2017 article in the CDC’s Morbidity and Mortality Weekly.

On Long Island, the number of opioid prescriptions per 100 people fell by more than half in Suffolk between 2012 and 2020, from 66.4 to 29.9, while Nassau’s rate decreased from 49.2 to 41.3, below the national rate of 43.3, according to the CDC. The rate includes people with multiple prescriptions in a year.

Experts say rates are declining in part because doctors turn to opioids more sparingly and there are more controls to flag physicians who prescribe unusually large amounts of opioids. In the past, people abusing opioids “would doctor-shop,” said Dr. Paul Pipia, president of the Medical Society of the State of New York and deputy medical director of Nassau University Medical Center in East Meadow. “There was no way to know who went where.”

There now is an electronic registry of patients’ controlled-substance histories that the state requires medical professionals to review before writing prescriptions. A law capping initial opioid prescriptions for acute pain at seven days, with refills only after further evaluation, limits overprescribing, Pipia said.

Pharmacists say ceilings on how many opioids they dispense each month mean that even though the number of opioid prescriptions is declining, they can't always fill them.

As part of a $21 billion settlement for their alleged role in the opioid crisis, the nation’s three largest pharmaceutical distributors agreed to increase their scrutiny of opioids and limit the quantity they send each pharmacy.

D’Angelo said if he runs out of his monthly opioid allotment, he has to make hard decisions on who gets their medications.

Mukash Patel, owner of pharmacies in Dix Hills and Patchogue, said he sometimes can’t get certain opioids “for days on end.”

“The patient should not have to run around calling 30 different places to see if the drug is in stock,” he said.

Often, pharmacies won’t tell patients if they have a medicine, so Rubin said his staff must make the calls.

“We don't have the bandwidth to be calling a dozen pharmacies for everybody who can’t get their medication,” he said.

Lauren Esposito, spokesperson for one of the distributors in the opioid settlement, Pennsylvania-based Amerisource Bergen, said in a statement that distributors “have been asked to walk a legal and ethical tightrope by both maintaining access to products while simultaneously limiting potential diversion.”

She called for better federal guidance “to support patient access.”

State opioid tax

D’Angelo said a state excise tax on most opioids, approved by the New York Legislature in 2019 as part of the state budget, aggravates the problem.

Wisconsin-based Independent Pharmacy Cooperative stopped selling opioids covered by the excise tax before it went into effect because “we thought that continuing to sell would likely mean that it would have been unprofitable,” said the company’s general counsel, Paul Karch. Last year, the company stopped selling all opioids nationwide because of high monitoring costs, he said.

Assemb. Linda Rosenthal (D-Manhattan), who headed the Assembly’s alcoholism and drug abuse committee when the tax was enacted, opposes the way the tax is structured because it can lead to higher prices for consumers, as well as lower supply. She called on the Department of Health to study the problem and find solutions.

Dr. Thomas Jan, a Massapequa pain management and addiction physician, said pain patients shouldn't have such difficulty obtaining prescribed medications. But, he said, in the past, many well-intentioned doctors were too quick to prescribe opioids, and they often prescribed too much, putting patients at increased risk of addiction. Jan said around 2010, his then-16-year-old son was prescribed 90 Vicodin pills after having a wisdom tooth pulled.

Dr. Yili Huang, a regional manager for pain management services for Northwell Health, said additional controls have caused doctors to think more carefully about alternatives to opioids. But opioids still have an important role, especially in relieving pain after surgery and for cancer, palliative and end-of-life care, he said.

Yet some doctors are hesitant to prescribe opioids, for fear of being “stigmatized as a doctor that prescribes a lot of opioids,” Huang said.

Rubin said he is conscious of the risk of developing dependence or addiction to opioids, so about nine in 10 of his new patients “probably will never see an opioid."

“We have more options than we ever had to treat patients with injections and those types of therapies,” he said.

Rubin most often writes opioid prescriptions for patients in severe pain after major surgery. For chronic pain patients who previously weren't prescribed opioids, “we’re really trying to save it as a last resort," he said.

The CDC’s 2022 guidance for opioid prescribing says there is insufficient evidence to determine the long-term benefits of opioid therapy for chronic pain. But, the CDC said, doctors should carefully weigh the risks and benefits of discontinuing opioids for those already prescribed them.

Rubin is reluctant to take chronic pain patients off opioids if the medication has been helping them long-term.

“There are lawyers and accountants and people like that who couldn't sit in a chair all day and work at their desk without their pain medicine,” he said. “Society has to separate those people who are using medication judiciously and not lump them in with people who are trying to take high doses in an abuse-type situation to get high.”

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During the 2022–2023 iohexol contrast media shortage, COVID-19 shutdowns reduced production, forcing hospitals to activate incident command centers, delay exams, repackage or substitute contrast, and spurring calls to diversify and localize manufacturing.

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Content: Newswise — OAK BROOK, Ill. (May 19, 2022) – Recent disruptions in a pharmaceutical supply chain have impacted the global availability of GE Healthcare Omnipaque™ iohexol iodinated contrast media (ICM) for radiologic examinations. A new Special Report published in the journal Radiology provides consensus recommendations for dealing with the shortage of ICM in the near term and discusses long-term issues and potential solutions to supply chain problems.

“We are facing issues similar to those we faced in the early days of the COVID-19 pandemic, caused by a limited supply of an important pharmaceutical, critical to our ability to care for our patients,” said Thomas M. Grist, M.D., chair of the Department of Radiology at the University of Wisconsin School of Medicine and Public Health in Madison and lead author of the Radiology Special Report. “One important difference, however, is that our hospitals and health systems are more adept at establishing incident command centers to implement rapid responses to the challenges we face and communicating those changes to our patients and referring physicians.”

Iohexol is a common agent used in a multitude of CT and X-ray exams. The iohexol shortage has created a national challenge to radiology’s collective ability to provide health care to patients needing these exams and will have short- and potentially long-term impact on quality medical care.

Although four companies supply ICM to the U.S., other manufacturers are unable to rapidly scale up ICM production to meet the demand created by the reduction in iohexol.

The shortage traces its origins to the recent COVID-19-related shutdown of a manufacturing facility in Shanghai, China. In an April 19 letter to consumers, GE Healthcare announced it would be limiting orders of iohexol. The facility has since reopened with production output currently at 50% and expected to increase. GE Healthcare has also expanded production capacity at its manufacturing site in Cork, Ireland.

“It is too easy for us to take for granted the readily available supply of something that is so important to our patients and our radiologic practices until it’s gone,” Dr. Grist said. “We need to commit to changing the supply chain so that a single event in a faraway country does not put us in this predicament again. We owe it to our patients who trust us with their lives and well-being every day of the year.”

The shortage has already had an effect on patient care. Across the U.S., hospitals dependent on iohexol are postponing treatment-monitoring imaging for cancer patients, as they attempt to preserve the contrast material for the most urgent cases.

The Special Report offers strategies for mitigating the impact of the shortage. Short-term strategies include establishing an incident command center to direct and monitor ICM usage, delaying elective contrast-enhanced CT exams, converting exams to non-contrast when possible, reducing contrast dose, and substituting other types of exams, such as MRI, ultrasound or non-contrast PET-CT.

Strategies for the coming months include contrast repackaging, multi-use, and multi-access tactics, negotiation with payers on billing and reimbursement, and consistent communication with ordering providers to ensure compliance.

Long-term strategies include advocating for legislation to facilitate contrast manufacturing plants in the U.S., improving institutional inventory of contrast supplies, and supporting the vendors to expand manufacturing.

“RSNA and its journals are committed to providing critical guidance to help our members navigate challenging times,” said RSNA President, Bruce G. Haffty, M.D. “This Radiology Special Report provides helpful strategies for managing the iodinated contrast shortage and offers practical recommendations for mitigating the impact of future shortages of this type on the radiology community and our patients.”

The authors hope that the radiology and hospital communities will take this lesson as a wake-up call to adapt the radiology supply chain to prevent similar emergencies in the future.

“We need to endeavor to ensure that companies with significant market share have diverse production locations and capacity,” Dr. Grist said. “We should also look at the ancillary components for ICM administration and make certain we have adequate supplies in stock. Any and all supplies we use may be the next subject of shortages over the next few months or years.”

See also: Iodinated Contrast Shortage Challenges Radiologists.

###

Short-, Mid-, and Long-Term Strategies to Manage the Shortage of Iohexol.” Collaborating with Dr. Grist were Cheri L. Canon, M.D., Elliot K. Fishman, M.D., Maureen P. Kohi, M.D., and Mahmud Mossa-Basha, M.D.

Radiology is edited by David A. Bluemke, M.D., Ph.D., University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, and owned and published by the Radiological Society of North America, Inc. (RSNA) (https://pubs.rsna.org/journal/radiology)

RSNA is an association of radiologists, radiation oncologists, medical physicists and related scientists promoting excellence in patient care and health care delivery through education, research and technologic innovation. The Society is based in Oak Brook, Illinois. (RSNA.org)

For patient-friendly information on contrast materials, visit RadiologyInfo.org.

SEE ORIGINAL STUDY

The FDA responded to oncology shortages by permitting temporary imports of some chemotherapy drugs such as cisplatin, while federal policymakers proposed $3.26–5.11 billion to strengthen supply resilience and urged greater manufacturer transparency and FDA authority. [22].

Pandemic-related supply disruptions also affected ADHD medications like Adderall, with manufacturers reluctant to fully disclose causes and capacity limits prolonging shortages.

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The shortage of 323 medical drugs is the worst since 2001.
According to the American Society of Health-System Pharmacis (ASHP), 323 medical drugs are currently in short supply, breaking the previous record of 320 shortages in 2014 and the most severe since tracking drug shortages began in 2001.
ASHP ’ s collaborative survey with the Utah Drug Information Service found that drug shortages in the United States are increasing and show no signs of improvement.
The institute said that all kinds of drugs are at risk of being out of stock, and the most worrying is the lack of even general injection disinfection drugs, including cancer chemotherapy drugs, and emergency medicine stores in hospitals and surgery departments.
Adderall, which is used to treat ADHD and narcolepsy, is one of the most difficult drugs to track and has been in short supply since October 2022. The Drug Enforcement Administration said last fall that more than a dozen pharmaceutical companies said they intended to increase adderall production, but ASHP noted that the problem persists to this day.
Members of the Society of Pharmacists say there is a national shortage of drugs to treat ADHD, which is still causing problems for medical personnel and patients.
Adderall will be short of loans, one of the reasons is that during the Covid-19 period, the use of large, delayed production by major manufacturers, and other manufacturers can not meet production targets.
In its quarterly report, ASHP noted that most pharmaceutical companies are reluctant to disclose the cause of the drug supply shortage.
Experts believe that the rapid increase in demand, supply is too late, pharmaceutical companies are limited, and the supply chain of pharmaceutical materials is blocked.
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In France, the medicines regulator signaled 4,925 shortages in 2023 (up from 3,761 in 2022), 44% of people reported facing a shortage in 2024, and 78% of oncology professionals experienced shortages, prompting pharmacy union strike plans and policy debate over transparency and reform.

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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French and EU responses included proposals for stricter supply obligations, earlier shortage notifications, requiring safety stocks, and shortening scientific evaluation timelines from 210 to 180 days to improve availability. [3].

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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Across the EU, governments also mitigated shortages by substituting similar medicines, changing formulations (e.g., pediatric syrups when tablets were scarce), and encouraging the sale of generics.

The EU discussed a solidarity mechanism to share medicines, created early warning for scarce drugs, allowed shelf-life extensions in emergencies, promoted joint procurement from 2024, and examined funding for domestic production to reduce reliance on imported ingredients.

Title:

Content: Brussels is planning for EU countries to share vital medicines and take emergency measures to avoid a repeat of shortages that hit the bloc a year ago.

The European Commission is proposing a “voluntary solidarity mechanism” requested by France and Germany and an early warning system flagging when drugs become scarce, according to draft proposals seen by the Financial Times. If insufficient donors come forward, EU capitals will be allowed to tap into an EU-funded stockpile set up during the Covid-19 pandemic and take other emergency measures.

In December and January western countries suffered a shortage of antibiotics including penicillin and amoxicillin, and painkillers such as paracetamol, especially in medicines used by children.

Among the emergency measures floated to prevent a repeat of that crisis, the commission could allow the extension of a drug’s shelf life, fast track approvals of alternative suppliers and support production increases.

Brussels will also encourage joint procurement of drugs from 2024 and medicine swaps with countries in the southern hemisphere, where peak winter demand happens at a different time.

The commission will draw up guidance for national stockpiles in 2024 and establish a Critical Medicines Alliance bringing governments, industry and civil society together. The commission declined to comment.

Three-quarters of countries reported a worsening of drug shortages in 2022, according to an industry survey. EU manufacturing is heavily reliant on imported active pharmaceutical ingredients from China and India.

Rising demand and disruption to supply chains have been compounded by inflation hitting the production of generic drugs, which typically sell at much lower prices than branded versions.

France has been actively encouraging the reshoring of basic medicine supply, with a giant paracetamol factory set to open in the country next year.

The EU is discussing whether to provide more funding for domestic production.

The commission’s proposal is scheduled to be approved on October 25 and could still change. Initially non-binding, it could lead to a Critical Medicines Act, with Brussels drawing up a list of vital medicines by year-end.

The commission also urges member states and the European parliament to approve its overhaul of pharmaceutical legislation, put forward in April. It includes plans to take control of drug production in the event of a public health emergency, a requirement for stockholders to inform Brussels of supply levels and for manufacturers to give early warnings of shortages.

An analysis by the European Medicines Agency and the commission found that unless there is unexpected demand the EU should avoid an antibiotics shortage this year.

“The information available today suggests that — if demand in the coming winter season does not differ significantly from the demand of recent years — the supply to the EU of key antibiotics seems to generally match demand,” the analysis said.

“However, this depends strongly on the compliance of industry with their legal obligations to ensure supply and their ability to adapt.”

Copyright The Financial Times Limited 2023. All rights reserved.
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Estonia’s shortages rose from 183 in 2021 to 450 in 2023 due to demand surges and active ingredient scarcity, affecting hospitals and patients; authorities extended discounts to some alternatives to maintain access.

Title:

Content: Drug supply problems have worsened in Estonia
This year, pharmacies in Estonia faced a much larger shortage of drugs than a year earlier.
Problems with supplies are caused by both increased demand and shortage of raw materials, reports rus.err with reference to "Actual chamber".
This spring, parents faced a shortage of antibiotics and antipyretic drugs suitable for children, and in the fall, the Sorbister drug for renal patients had to be issued from the state reserve stock, since it was not enough due to supply problems in pharmacies.
Hospitals are also facing a severe shortage of medicines this year.
“For example, hospitals use very important drugs to treat the consequences of heart attacks and strokes, the supply problems of which have been observed for a year, but thanks to good cooperation, we were able to ensure that no one was left without treatment, ” said Marco Tiisler, head of the Import and Export Supervision Department of the Drug Department.
In 2021, there was a shortage of 183 drugs in pharmacies, last year - 359, as of the end of this year - 450 drugs, and in the case of 130 drugs, the cause of the deficiency is unknown.
The second significant reason was a sudden surge in demand, for example, for the drug Ozempic, which is popular among those who lose weight, but drugs can be in short supply due to problems with production.
- Producers lack the active ingredient.
The active substances come from third countries, they are not always available, this was stated by one of the largest European manufacturers of antibiotics, - said Tiisler.
Drug supply problems put not only patients in a difficult position, but also doctors who have to quickly find replacements, sometimes in conditions of scarce information about alternatives.
If earlier, in the case of a shortage of drugs, the patient had to pay the full cost of the drug prescribed as a substitute, recently the Health Insurance Fund, as an exception, decided to extend the discount to some alternatives.
According to Lee Rootslane, head of the Union of Pharmacies, problems with the supply of medicines are a growing problem throughout Europe.
- This year, in cooperation with the Drug Department and family doctors, we made recommendations so that if a problem arises, we do not solve it after the fact, but try to provide some solutions and avoid panic.
In the case of children ’ s syrups, people read about the shortage of syrup, went to the pharmacy and took two syrups instead of the usual one, ” Rootslane said.
The drug department recommends having a weekly supply of non-prescription drugs and a monthly supply of prescription drugs at home.
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Ireland faced a nationwide paracetamol shortage during concurrent COVID-19 and flu waves in 2023, with resupply expected from two suppliers while pharmacies maintained continuity through alternative strengths and generic substitutions.

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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India experienced recurring anti-TB drug shortages that disrupted treatment, increased the risk of drug-resistant TB, and imposed out-of-pocket burdens and repeated clinic visits on patients, prompting activists to call for transparent accounting and emergency procurement.

Title:

Content: Advertisment

TB and HIV Advocates Appeal to PM Modi Over Anti-TB Drug Shortages Ahead of World TB Day

Activists and health experts urgently request PM Modi's intervention on the eve of World TB Day to address the ongoing anti-TB drug shortages across India.

BNN Correspondents
New Update

In a significant plea for intervention, activists, public health experts, tuberculosis survivors, and individuals living with HIV have sent a distress letter to Prime Minister Narendra Modi on the eve of World TB Day, urgently requesting his attention to the ongoing shortages of anti-TB drugs across India. This call to action underscores the dire situation for those afflicted by tuberculosis, emphasizing the need for immediate governmental response to prevent further health crises.

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Urgent Call for Governmental Action

The letter addressed to PM Modi detailed the specific anti-TB drugs currently in shortage, particularly those vital for treating drug-sensitive tuberculosis (DS-TB). The activists highlighted the grave implications of these shortages, including treatment disruptions and the heightened risk of drug-resistant TB strains. This situation not only jeopardizes the health of individuals currently undergoing treatment but also poses a significant threat to public health at large. The communication also shed light on the logistical challenges and bureaucratic delays in drug procurement at the state level, further exacerbating the issue.

Impact on Treatment and Patient Lives

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The consequences of these drug shortages are far-reaching, affecting TB patients' ability to adhere to their treatment regimens. Many are forced to make repeated visits to health centers, often at the cost of their day's wages, posing a harsh dilemma between earning a livelihood and seeking life-saving treatment. The letter poignantly outlines the predicament faced by those who, due to the unavailability of drugs, might have to purchase medication out-of-pocket, a financial burden too heavy for many to bear. This crisis highlights the urgent need for a streamlined and effective response to ensure the availability of essential TB medications.

Previous Denials and A Call for Transparency

Despite previous denials from the Health Ministry regarding the existence of such shortages, the persistence of this issue speaks volumes. The activists' letter calls for a transparent and accountable approach to addressing these shortages, urging the government to undertake emergency procurement measures and ensure the uninterrupted supply of these critical drugs. As the country with the highest burden of tuberculosis globally, India's response to this crisis will be closely watched by the international community and public health advocates alike.

As World TB Day approaches, this urgent appeal to Prime Minister Modi serves as a reminder of the ongoing struggles faced by those living with tuberculosis and HIV in India. The resolution of the anti-TB drug shortage crisis not only requires immediate governmental intervention but also a long-term commitment to strengthening India's healthcare infrastructure to prevent such situations in the future. The health and well-being of millions hang in the balance, awaiting decisive action.

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In Egypt, an insulin shortage threatened lives as prices jumped from 62 to 192 pounds, with high exchange rates raising raw material costs, leaks to the black market, and calls for legislation, local manufacturing, and stockpiling to protect patients.

Title:

Content: The Egyptian alternative is not available.. and the importer increased 150% search for insulin..
A journey of misery that threatens the lives of diabetic patients
5.
There is no voice louder than the cries of patients who have failed to get their medicine.. The crisis of lack of medicines continues and haunting patients and threatening their lives.. The most prominent shortcomings of insulin.. In the new republic, access to insulin has become a difficult dream.
Insulin disappeared from pharmacies.. The Right to Medicine Association also received many complaints about the lack of insulin in public hospitals and health insurance clinics in the provinces.
Some patients resorted to the ambulance pharmacy in search of insulin, which is dispensed in specific quantities after providing a modern prescription and analysis proving the patient's diabetes, which prompted citizens to crowd in front of the ambulance pharmacy in long queues to buy those shortcomings after they disappeared from all pharmacies.
The lack of insulin prompted a number of patients to share their suffering on the social networking site Facebook and wondered where it was available.
The price of imported insulin pen rose from 62 pounds to 100 pounds and then 150 pounds up to 192 pounds.. The local price reaches 40 pounds, but it is not available only in the ambulance pharmacy and the patient spends one pen after submitting the prescription and a copy of the card and the analysis that proves the disease.
The crisis is not limited to pharmacies and government and university hospitals, but there is a shortage of insulin in health insurance pharmacies.
Many diabetic patients have complained of not being able to dispense their monthly treatment due to the lack of insulin.. The patient also has to pass through many pharmacies on a long journey to dispense his treatment and there are some pharmacies that dispense half the dose only because of the existing shortage.
The government held several meetings to discuss the drug shortage crisis and promised to solve it within a week.
The crisis prompted a number of deputies to submit requests for a briefing in the House of Representatives on the crisis of the shortage of medicines for chronic diseases such as heart, pressure and diabetes … and accused the Unified Procurement Authority and the Ministry of Health of failing to resolve the crisis.
Mohamed Elbahi, consultant of the Chamber of Pharmaceutical Industry at the Federation of Industries, said that the shortage of medicines in Egypt is caused by the high prices of raw materials due to the high exchange rate, as most of the raw materials used in the pharmaceutical industry are imported from abroad.
I forgot to solve the crisis in stages so as not to impose a burden on the citizen and expect the end of the crisis of medicine shortages within three months at the latest.
Although Egypt imports a large amount of insulin, the Minister of Health and Population, Dr. Khaled Abdel Ghaffar, said in statements that Egypt is a producer of insulin, and local insulin can be used as an alternative to the importer, but it is also not available.
As pointed out by dr.
Alaa Mohamed, a pharmacist, said that there is a prevailing culture among citizens that the importer is the best and despite the high price of imported insulin, but the patient is still looking for him and is not satisfied with the alternative.. There are patients suffering from diabetes for several years and they are accustomed to the importer and it is difficult to replace it with the Egyptian.
Dr. Ali Abdullah, director of the Center for Pharmaceutical Studies, explained that the reason for the shortage of medicines is the inability of the producing companies to bear the difference of money to import raw materials after the rise of the dollar price from 31 pounds to 49 pounds.
He pointed out the need to raise the awareness of citizens and change the prevailing culture that the importer is better than the local. We must educate patients to use alternative medicines because they are much cheaper than the importer, which costs us a lot of money.
He added that it is necessary to enact legislation to prevent the dispensing of medicines without prescription in order to prevent the withdrawal of medicines and their use for purposes other than those specified for them.
On the other hand, Dr. Ali Abdullah called for the need to reconsider the pricing of medicines with not forgetting the social and investment part of companies.. And the citizen to accept the increase in the prices of medicine, and also must control the market of medicines.. There are statements by Minister Dr. Khaled Abdel Ghaffar pointed out that the private sector represents 70% of medicines, and the government has 30%.. Unfortunately there is a large amount of government medicines private hospitals and pharmacies health insurance are leaked For the black market and the citizen does not find evidence in a syringe price of 200 pounds sold for 2000 pounds.. In a drug used in illegal abortion price of 11 pounds is now sold for 200 and 300 pounds although it is private government only.. And on the private level we find abuse in the use of drugs veterinarians sell veterinary drugs with feed..
And gynecologists and obstetricians sell the IUD at times its prices and hormonal injections as well.. Where is the legislation that governs this farce and where is the drug traceability that governs the medicine can.
Dr. Irene Saad, a member of the House of Representatives, pointed out that the reason for the shortage of medicines, especially medicines for chronic diseases, is the decline in the import of raw materials and the tendency of some factories and companies to stop production lines because of the lack of raw materials for the industry due to the high price of the dollar.
She stressed that the role of the state is to pay attention to the factories of the private business sector in the country, which can feed the gap in public hospitals and health insurance, and there is more interest in the city of medicine to serve the national industry, and there is a national strategy to localize the drug industry and rely on local alternatives.
It is possible to agree with the Ministry of Agriculture to provide animal gelatin.. Packaging materials.. Manufacturing these materials locally can save the final cost and reach a fair price for medicines..
Therefore, the state should give incentives to important production lines that fill a deficit.. There must be coordination between the Pharmaceutical Authority and the Ministry of Industry to identify the shortcomings and develop alternative plans to provide them at reasonable prices.
She pointed out that insulin, for example, from medicines should be in stock at least 6 months because of its great importance in providing health care to citizens, and there should be stock for all medicines, especially medicines for chronic diseases.

Jordan’s public hospitals reported shortages tied to delayed payments and accumulated debts to suppliers, weak coordination, and inaccurate forecasting, which strained patient safety and budgets and led to calls for fiscal reforms and better planning.

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.

Saudi Arabia received 107,246 shortage reports in Q1 2021—roughly 50 per hour—and an operations room resolved 98.95% of medicine shortage complaints and 99.34% of vaccination shortage complaints that quarter.

Title:

Content: Saudi News
There are 50 urgent reports every hour about the shortage of medicines in Saudi Arabia.
The Ministry of Health revealed that it received 107,246 reports during the first quarter of this year 2021 regarding the lack of medicines and vaccines in hospitals and health centers affiliated to the Ministry, with 1,191 reports daily and 50 reports every hour.
According to official data issued by the Ministry, during the first quarter of this year, the health received 67,065 reports related to the lack of medicines, in addition to 40,181 reports on the lack of vaccinations in health centers.
In order to solve the problem of shortage of medicines and vaccines, the ministry said that it has established an operations room to follow up reports of shortage of medicines to identify the challenges facing health facilities in providing medicines to beneficiaries, which reduced the number of weekly reports.
Statistics of communications

Lack of medicines in the hospitals of the Ministry of Health.
Description of the communication
Reports received from some beneficiaries related to the lack of availability of the medicine disbursed to them by the establishment.
Number of complaints closed
 98.95%
Number of communications
 67065
Source of the communication
Call Center « 937 » - « Twitter »
Service Evaluation
 85.81%

Lack of vaccinations in health centers
Description of the communication
Notifications received from some beneficiaries who did not receive vaccinations service.
Number of complaints closed
 99  34%
Number of communications
 40181
Source of the communication
Call Center (937) - Twitter
Service Evaluation
 88.82%
Report Period
 Q1 - 2021
Report Period
 Q1 - 2021
Decision for improvement
An operations room has been established to follow up reports of lack of medicines to identify the challenges facing health facilities in providing medicines to beneficiaries, thus reducing the number of weekly reports.
Decision for improvement
A weekly report containing the most important challenges leading to the lack of vaccinations was directed to be prepared and presented to leaders on a regular basis, which led to a reduction in the number of reports related to this classification.
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China strengthened its national shortage management in 2023 by improving a four-level classification system, enabling temporary imports of urgent drugs, enhancing production and pricing monitoring, and prioritizing rural facilities through a daily dispatch and supply coordination system. [9].

Title:

Content: Health · Life
How to solve the problem of drug shortage in rural areas?
National Health Commission response
January 07, 2023 17: 26 Source: People 's Daily Online
Beijing, January 7 (Reporter Yan Yan Yan) Today, the joint prevention and control mechanism of the State Council held a press conference to introduce the situation of epidemic prevention and control in rural areas and answer questions from the media.
At the press conference, a reporter asked, recently, many township health centers and village health rooms have a shortage of drugs and other problems, how to properly solve?
Nie Chunlei, director of the grass-roots department of the National Health Commission, said that rural areas are the focus of epidemic prevention and control and are also weak links.
The joint prevention and control mechanism of the State Council has attached great importance to the prevention and control of the epidemic in rural areas and made a lot of arrangements for deployment.
There is a shortage of medicines and other medical supplies in rural areas, for three reasons: First, the production capacity of individual medicines is insufficient, and the supply is in short supply.
Second, the information between the supply and demand sides is not smooth.
Third, logistics reasons, some purchased drugs can not be delivered in time, resulting in a shortage of drugs.
In response to the shortage of drugs, the state has taken a series of measures, Nie Chunlei said. First, the material support group of the joint prevention and control mechanism of the State Council has established a daily dispatch system to coordinate the daily dispatch of drugs and other key medical supplies.
According to the development of the epidemic, priority is given to medical institutions in rural areas, especially in rural areas.
For some drugs that are in short supply, those with insufficient production capacity, actively coordinate and expand production capacity.
Relevant departments have formulated policies to support relevant enterprises to expand production capacity, mobilize the enthusiasm of enterprises, and work overtime to produce relevant drugs.
The second is to strengthen supply and demand docking.
Rural areas have a wide range of points and long supply chains, and if the docking of supply and demand is not smooth, the problems reflected by the grassroots may not be timely feedback.
Local governments are encouraged to focus on procurement.
All localities should strengthen the docking of supply and demand through material support groups to solve the shortage of medicines in a timely manner.
Third, adhere to the combination of Chinese and Western medicine, rational selection of Western medicine, Chinese patent medicine and traditional Chinese medicine decoction.
Local governments, especially in rural areas, should be encouraged to give full play to the characteristics of rural areas, make full use of traditional Chinese medicines, alleviate the problem of insufficient medicines, and reduce the pressure on grass-roots medical care
Nie Chunlei said: "From the current monitoring situation, the shortage of medical supplies is more prominent, but recently with the development of the epidemic and the growth of drug production capacity in various localities, the coordination of material support groups and logistics is smooth, and the local government Strengthen the organization, the problem of drug shortage is gradually improving.
(Editor: Yang Di, Gao Lei)
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The World Health Organization warned in November 2021 of a global shortage of up to 2 billion injection devices due to massive COVID-19 vaccination demand, threatening vaccination campaigns unless supplies stabilized.

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Content: 19: 53 GMT09 November 2021
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The World Health Organization (WHO) warned on Tuesday of the risk of a worldwide injection shortage of up to 2 billion units by next year, threatening to disrupt vaccination efforts.
The shortfall is mainly due to COVID-19 vaccination campaigns, where billions of injections are used more than usual around the world, which has negatively affected the world ’ s supply of this essential tool.
The World Health Organization ’ s senior adviser on securing access to medicines and health products, Lisa Hedman, said that as the supply of doses of the coronavirus vaccine increases, the supply of injections must be kept up.
"We are raising real concern that there may be a shortage of immunization syringes, which in turn will lead to serious problems, such as slowing down vaccination efforts."
And she went on to say:
"Depending on how the vaccine is absorbed, the deficit could range from 1 billion to 2 billion injections."
More than 7.25 billion doses of the coronavirus vaccine have been given to the global population, nearly double the number of routine vaccinations given annually and double the number of injections required, according to an AFP tally.
See also:
World Health Organization: The pace of coronavirus transmission in Europe is very worrying
WHO approves emergency use of India ’ s Covaxine anti-coronavirus vaccine
WHO resolves controversy over combined coronavirus and flu vaccines
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Coronavirus, WHO

WHO and partners also addressed critical medical supply gaps by launching the COVID-19 Oxygen Response Task Force to link countries with financing and support oxygen procurement in low-income settings.

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Content: UN: High pressure on oxygen supply in low-income countries
KATHAN / NOURSUDAN, Feb. 24 (Xinhua) -- Affordable and sustainable oxygen supply has been a growing challenge in low- and middle-income countries since the COVID-19 pandemic, according to a United Nations news release.
The COVID-19 pandemic has put enormous strain on health systems in these countries, with hospitals in many low-income countries running out of oxygen, leading to preventable deaths.
Although oxygen as a basic drug is essential for the effective treatment of hospitalized COVID-19 patients, access to oxygen is limited in low- and middle-income countries due to cost, infrastructure and logistical barriers.
Sanitation facilities often lack access to the oxygen they need, leading to unnecessary loss of life.
It is estimated that more than half a million people in low- and middle-income countries need 1.1 million cylinders of oxygen per day, while 25 countries are currently reporting a surge in demand, most of them in Africa.
This supply was limited before the COVID-19 pandemic and exacerbated by the pandemic.
Under the Accelerated Access to COVID-19 Tools Programme, UNITAID, the Wellcome Trust and WHO launched the COVID-19 Oxygen Response Task Force.
UNITAID stressed that this is a global emergency that requires a truly global response from international organizations and donors.
Many countries with this need struggled to meet their daily oxygen needs before the pandemic.
Now more than ever, there is a need to unite, build on what has been done, and commit firmly to helping the most affected countries as soon as possible.
The task force is currently in urgent need of $90 million in funding to address key challenges in oxygen access in up to 20 countries, including Malawi, Nigeria and Afghanistan.
The Task Force focuses on measuring acute and long-term oxygen demand in low- and middle-income countries; linking countries with financing partners to meet oxygen demand; and supporting the procurement and supply of oxygen and related products and services.
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To build longer-term resilience, the WHO established an mRNA Technology Transfer Centre in South Africa and backed additional sites (e.g., Kenya) to expand local vaccine manufacturing capacity and reduce dependence on strained global supply chains.

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Content: Tuesday, 07 November 2023 01: 24 GMT
WHO: Egypt has developed its national vaccine capacity and reached maturity level 3
Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), said in a statement: “The coronavirus pandemic has shown the incredible power of vaccines, tests, treatments and other medical technologies to save lives, but it has also revealed the enormous inequalities in our world, in terms of access to those products, and, of course, this is not the first time. ” When HIV emerged more than 40 years ago, life-saving drugs were developed, but it was more than a decade before the world ’ s poor had access to them.
Egypt, for example, has launched a program.
In January this year, which brings together public and private sector manufacturers with different areas of expertise, Egypt has also developed its national capabilities, and has now reached the third maturity level of the World Health Organization (WHO) regarding vaccine regulation, I congratulate the Minister of Health and Population Dr. Khaled Abdel Ghaffar for the remarkable progress achieved.
Tedros said the program now includes a network of 15 recipient countries around the world, including five in Africa, adding that at the World Health Assembly in 2021, member states agreed on a resolution to boost local production of medicines and other health technologies.
In the same year, WHO and its partners established the mRNA Technology Transfer Centre in South Africa, to build sustainable manufacturing capacity in low- and middle-income countries to combat coronavirus and other global health threats including malaria, tuberculosis and cancer.
He noted that Kenya is also setting up a manufacturing facility from scratch.
During the construction of the KEMRI National Research Institute, he will receive mRNA technology on a research scale to promote the search for new vaccines tailored to the needs of the country and the region.
In India, the BiologocalE Technology Receiving Program is one of the program ’ s most advanced partners, and we have recently begun expanding the Indian network to include academic institutions.
We have also established the first global bio-manufacturing training centre in the Republic of Korea, so that the new facilities can be equipped with a skilled workforce, trained in general bio-manufacturing processes in an industrial environment.
Based on the lessons learned from the COVID-19 pandemic, we have also developed a proposal for a temporary mechanism for equitable access to medical countermeasures.
Commitment to local production and equitable access is also a key part of the epidemic agreement that countries are now negotiating, and the Second Global Forum on Local Production again brings together health, industry, trade and other sectors with manufacturers, civil societies, associations and other key actors.
We expect this forum to stimulate coordination, collective action and partnerships within national and regional ecosystems for technology transfer and sustainable local production.
There are many practical things governments can do, with the support of WHO and other partners, to strengthen the ecosystem for local production.
Provide an enabling environment, with policies and regulations to streamline approval processes, provide incentives for local production, and ensure compliance with quality standards.
Second: Provide investment and financing, through grants, tax incentives or low-interest loans to encourage private sector participation in local manufacturing.
Third, facilitate the exchange of knowledge and technology between the public and private sectors, through the promotion of research cooperation, and support the transfer of industrial knowledge.
Fourth: Building the capacity of the workforce, through training programs to increase quality, improve efficiency, and encourage innovation.
Fifth, ensure market access for local manufacturers by improving supply chain management and expanding market access.
When the H1N1 pandemic broke out 14 years ago, vaccines were developed, but by the time the world ’ s poor had access to vaccines, the pandemic was over.
The COVID-19 Accelerating Access to Anti-Coronavirus Tools Program and the Kovacs facility have delivered nearly 2 billion doses of vaccine to 146 countries, in addition to millions of tests, treatment cycles, medical oxygen and personal protective equipment, but narrow nationalism and hoarding by high-income countries meant many low-income countries got too little and too far. Time. Time.
Similarly, the Korona-19 technology access complex, or C-TAP, was created as an innovative platform for vaccine, testing and treatment developers to share their intellectual property and knowledge with manufacturers in low-income countries, but few manufacturers were willing to participate, so one of the most important lessons learned from the epidemic is that the ability to manufacture drugs, diagnostic vaccines and other technologies is a key component of the epidemic. The tools are concentrated in very few countries.
Expanding domestic production, and strengthening domestic regulatory capacity, is essential to reducing health inequalities between and within countries – not only for tomorrow ’ s environments, but also for today ’ s diseases.
“Access to high-quality medicines is a key priority for WHO and our Member States, ” he said, explaining that since 2018, WHO has supported more than 7,000 manufacturers, regulators and other stakeholders from more than 70 countries around the world to build their local manufacturing capacity. Coronavirus outbreak.
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In the United States, shortages rose 30% in 2022, with sterile injectable generics, conventional antibiotics, and anesthetics often affected, and policymakers linked the heavy reliance on offshore production to national security risks and patient harm.

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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.
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Hospital pharmacists reported near-record shortages, with 309 drugs in shortage and one in three health systems delaying, canceling, or rationing care, underscoring sustained patient-level impacts.

At the system level, authorities and providers coped through emergency imports, therapeutic substitution, rationing protocols, early-warning mechanisms, joint procurement, and proposals for transparency, safety stocks, and diversified or reshored manufacturing. [22][8][28].

These cases show how manufacturing disruptions, sudden demand surges, and opaque or fragile supply chains translated into delayed treatment, forced substitutions, higher prices, and anxiety for patients—and how regulators and health systems responded with both immediate mitigations and structural reforms. [1][3][21].