# Global Medication Shortages: A Comprehensive Report (2021-2024)

## Executive Summary

Medication shortages represent a critical global healthcare challenge affecting both developed and developing nations.

This report examines the scope, causes, and impacts of medication shortages between 2021-2024, with particular focus on life-saving medications for chronic conditions.

The analysis reveals systemic vulnerabilities in global pharmaceutical supply chains that directly impact patient care and require immediate attention.

## Scope of the Problem

### Global Impact
Medication shortages are a worldwide phenomenon affecting healthcare systems across all economic levels.

Reports from multiple countries including the United States, Egypt, Palestine, Lebanon, and India demonstrate that no nation is immune to this crisis.

The shortages affect essential medications across various therapeutic categories, creating widespread challenges for healthcare providers and patients.

### Affected Medications and Medical Supplies
Based on documented cases, the following categories have been significantly impacted:

- **Antibiotics**: Amoxicillin shortages

# Global Medication Shortages: A Comprehensive Report (2021-2024)

## Executive Summary

Medication shortages represent a critical global healthcare challenge affecting both developed and developing nations.

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

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Content: LATEST NEWS
"We aim to bring medicine closer to the patient of Deep Algeria"
+ -
In an interview with Al-Khobar on the sidelines of the National Symposium of Algerian Pharmacists, the Director General of the Central Pharmacy, Mr. Ferhat Samir, stressed that there are efforts to provide medicine to patients in Algeria, including bringing medicine closer to patients in deep Algeria, and informing the cancer patient of medicines that were scarce in past times, explaining these and others in his next dialogue.
The central pharmacy is pointing fingers at hospitals about the scarcity of medicines, can you tell us about the responsibility of the institution towards this problem?
...
After I assumed the position of Director General of the Central Pharmacy of Hospitals, and after the preliminary analysis we carried out and the disclosure of the figures, it was obvious to announce some imbalances that were recorded at the level of the central pharmacy stores of hospitals, and in this area we had the first statements in which we announced the shortcomings that we recorded with regard to the depletion of a number of drugs, including cancer drugs. My first statement was about the lack of availability of 27 of the 121 drugs registered in the Central Pharmacy of hospitals blog, which has already negatively affected the effectiveness of the treatment provided by cancer treatment centers.
But the efforts exerted by all the workers of the central pharmacy of the hospitals, especially those related to the re-sending of requests for proposals, which had previously been declared useless, which we re-sent and enabled us to register and sign the appropriate contracts, for the acquisition of medicines and medical supplies with which we supported our warehouses and hospital pharmacy stores.
In this regard, he explained that as of September 2022, there was a continuous support for the stock of about 558 products for all therapeutic categories, including 105 products for the treatment of cancer patients, which enabled us to register a kind of stability, especially with regard to the drugs of cancer patients, which are affected by scarcity in particular. I would just like to clarify that the delay in receiving medicines has nothing to do with financial problems, especially since the debts of the central pharmacy of a number of hospitals, part of which has been paid by the public authorities, where the budget of the central pharmacy of hospitals has been strengthened by 75 billion dinars, represented by the debts paid under the Finance Law 2022, with a similar amount of 75 billion dinars, within the Finance Law 2023 will be paid in due time.
During your intervention at the opening of the National Symposium of Algerian Pharmacists, you promised that the month of Ramadan will be a good opening for our patients, as the scarcity of medicines will be eliminated before it arrives.
...
Indeed, she announced that the elimination of the scarcity of drugs for cancer drugs will be before the month of Ramadan, and confirmed that we will reach zero scarcity, God willing.
In order to clarify this point, it was pointed out that the measures taken in this area have made it possible to sign 98 contracts with the suppliers of the central pharmacy of hospitals. In order to eliminate scarcity, and in accordance with the laws and regulations available, we have initiated a procedure that allows us to enter into capital and buy shares with the supplier. Thus, everything that hinders the supply of medicine should be overcome.
Can you tell us about the future projects of the Central Hospital Pharmacy in bringing medicine closer to the patient across the country?
...
You should know that the central pharmacy of the hospitals has started to register some projects for the construction of accessories throughout the country, where an annex has been placed at the level of the province of Setif, which we will receive in the next few days, in addition to the supplements of Adrar, Warfala and Aghouat, which will start construction soon, not to mention the supplements already available, which are located throughout Annaba, Oran and Algiers. The expansion of the central pharmacy annexes to the hospitals is part of bringing the drug closer to the patient, as it will enable us to distribute the most appropriate drugs and deliver them to patients in Algeria.
Finally, Sir, you announced the availability of innovative medicines to the patient of Algeria in the near future, what about this procedure?
...
We have registered innovative medicines at the level of the National Agency for Pharmaceutical Materials, and we have placed them in the Central Hospital Pharmacy Acquisitions Code. These are about 30 innovative medicines for the treatment of various diseases, especially incurable ones, including cancer and other diseases such as blood diseases, selected in the framework of the various requests for proposals, with a special table for these products. The first year of the acquisition of these medicines will be a year of evaluation for us, and if there is no good return on the health of the patient, we will stop the acquisition of these medicines, especially since the contracts we signed are annual contracts that can be renewed or suspended.

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Content: Healthcare companies moved higher as tech companies continue to enter the space.

Facebook parent Meta Platforms has created a tool to predict the structure of hundreds of millions of proteins using artificial intelligence. Researchers say it promises to deepen scientists' understanding of biology, and perhaps speed the discovery of new drugs.

Meanwhile, a drug used to extend the lives of people with advanced prostate cancer is in short supply and will be for months, leaving some patients with no treatment option as the manufacturer works to ramp up production. The Food and Drug Administration said last week the availability of Pluvicto is limited as manufacturer Novartis struggles to meet demand. The drugmaker said the shortage stems from manufacturing and delivery issues.

Write to Amy Pessetto at amy.pessetto@dowjones.com

(END) Dow Jones Newswires

03-16-23 1727ET

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World Health Organization warns of antibiotic crisis
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17
MARCH
2023.
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A new health analysis has revealed an acute shortage of antibiotics under development, particularly those needed to target potentially dangerous diseases.
A WHO review shows that only 12 new types of antibiotics entered the drug market over the five years from 2017 to 2021, and that 27 types of antibiotics are currently under development in clinical trials against pathogens deemed “critical, ” numbers that the WHO considers too few.
The update for the new antibiotics was published on Wednesday ahead of the European Conference on Microbiology and Infectious Diseases in Copenhagen, which will take place from April 15 to 18.
Of the 27 antibiotics under development, only six are considered "innovative" enough to be able to overcome previously popular antibiotic resistance, and two of the six target high forms of that resistance.
Valeria Gigante, who leads the WHO ’ s antimicrobial resistance department in Geneva, said in a statement: “In the five years covered by this report, we have only obtained 12 approved antibiotics, with only one of them capable of targeting all pathogens that the WHO considers critical. ”
"It is difficult to predict whether and when these drugs will be licensed because failure is still a possibility in the later stages of trials."
Pharmaceutical companies are often not enthusiastic about developing antibiotics because these treatments are usually short term and less profitable, the WHO report said, noting that they make up a small fraction of the revenue for companies compared to treatments for diseases such as cancer and heart problems.
“The increase in microbial resistance to popular antibiotics around the world is extremely worrying, and without immediate action we risk a return to the pre-antibiotic era, where infections spread and become deadly. ”
“Through increased investment and collaboration, we can make progress in the fight against antimicrobial resistance and ensure that patients have equitable access globally to effective treatments for infections, ” she said.
Venkatasupramanian Ramasupramanian, president of the Society of Clinical Infectious Diseases of India, said: “The world is already living in a post-antibiotic era. ”
“We lack a sustainable economic model for antibiotic innovation.
The current products under evaluation mainly meet the requirements of developed countries, resulting in an imbalance relative to those that must be made available to developing countries. ”
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He is expecting a breakthrough in the drug crisis.
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AUGUST
2021.
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The Minister of Public Health in the caretaker government, Dr. Hamad Hassan, held a meeting with the heads of directorates and departments in the Ministry of Public Health, in which he discussed the path that is being followed to devise solutions in the health field, especially with regard to the crisis of medicine and the hospital sector.
In his intervention, Hassan was keen to thank the staff of the Ministry individually because they are still committed to supporting the citizen despite all the difficult circumstances prevailing.
With regard to medicine, he announced a recent agreement reached after several meetings including the Pharmaceutical Importers Syndicate and the Central Bank, in which the bank confirmed the continuation of the monthly support of the drug in the amount of fifty million dollars, and began to see the effects of this in the hope of continuing to regulate imports as quickly as possible, as pledged by the importing companies of medicines under some detail that is coordinated with the bank.
In this regard, Minister Hassan announced that "the Central Bank approved three weeks ago bills for pharmaceutical companies worth eighty-seven million dollars (87 million dollars), and a week ago on eleven million dollars (11 million dollars), adding that today the Central Bank approves the import of medicines worth thirty million dollars (30 million dollars), which must achieve a breakthrough in the drug crisis in a period ranging from five days to a week, especially with regard to medicines for cancer and incurable diseases." Infant Vaccines and Baby Milk ".
The Minister of Public Health confirmed that he is in the process of forming the technical academic committee to study the files submitted for emergency import under conditions that ensure quality and competitive prices, hoping that permits will be given to this import at the beginning of next week.
He called for "not to rely on the negatives marketed in some media and social media," stressing that the Ministry of Public Health "is reliable and works within the laws in force, and all it aspires to at this stage is to succeed in keeping up with the citizen in this crisis and alleviate its burdens."
He added: “Today, the pricing index was introduced by adhering to sixty-five percent of the market exchange rate. ”
Minister Hassan explained that the pricing on 12 thousand Lebanese pounds took into account that the companies bear 15 percent on the basis of the 85 / 15 agreement and 20 percent marketing, distribution and conferences is not the time now, so 35 percent of the market price is deducted; if this price is 18 thousand Lebanese pounds becomes 12 thousand pounds after the aforementioned discount, and if the exchange rate 21 thousand pounds becomes 13 thousand and five hundred pounds after the discount.
He pointed out that the final decision regarding the pricing of OTC and Acute drugs has been issued and all warehouse owners, importers and stockholders should know this, and the importers union is aware of this, and 90 percent of importers have agreed to import within the pricing of 65 percent of the dollar exchange rate in the market.
Hospitals
Hassan addressed the issue of hospitals, stressing that "in coordination with the Deputy Prime Minister and Minister of Defense, Ms. Zeina Akar, the adoption of a new tariff soon for medical laboratory and radiological works," adding: "The insurance of fuel for hospitals was discussed yesterday in the government serail, where the Minister of Energy unanimously adopted the provision of fuel for hospitals and not to abandon them."
"The hand is extended to anyone willing to help."
Pandemic.
On the epidemiological issue, Minister Hassan pointed to a "significant increase in cases," wishing citizens "to register on the vaccine platform, noting that this registration achieved a record yesterday with the number of twenty-two thousand people," thanking all those who help the Ministry of Public Health, whether the World Bank or friendly countries that provide donations of vaccines such as Kuwait and Qatar.
Minister Hassan renewed the call for "the adoption of muzzle and distance and the conduct of activities in the open air, especially with the presence of a large amount of expatriation in Lebanon," regretting the difficulty of tracking expatriation and contacts, as it turns out that "the phone numbers given to teams monitoring the ministry are inaccurate, which poses a danger to society."
He mentioned the two hot numbers for receiving complaints, communications and reviews: 1214 and 1787.
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Content: 2 major drugs are in short supply, FDA says. Both are widely prescribed to children.

NEW!

Drug shortages continue in the U.S., even as the COVID-19 pandemic nears the end of its third year.

Two drugs commonly prescribed to children — Adderall and liquid amoxicillin — recently joined the list, the Food and Drug Administration says.

The FDA announced last month that it was talking to manufacturers about a shortage of Adderall, the combination drug of amphetamine mixed salts used to treat attention deficit hyperactivity disorder.

Parents are also discovering liquid amoxicillin — an important antibiotic used to treat bacterial infections — is in short supply, according to the FDA. It added the oral solution of the antibiotic to its list of drug shortages on Oct. 28.

Both drugs are widely used by children as well as adults. The amoxicillin shortage comes at a vulnerable time, as we enter cold and flu season and U.S. hospitals continue to fill with respiratory infections. Amoxicillin is often used to treat ear infections and bronchitis.

The reason for the shortages? The FDA didn’t immediately respond to a request for comment Thursday. However, the agency cited a few factors on its website, including quality and manufacturing issues.

“There have been other reasons such as production delays at the manufacturer and delays companies have experienced receiving raw materials and components from suppliers,” the agency says. “Discontinuations are another factor contributing to shortages.

“FDA can’t require a firm to keep making a drug it wants to discontinue. Sometimes these older drugs are discontinued by companies in favor of newer, more profitable drugs.”

For a list of all drugs currently in short supply, visit FDA.gov.

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Spencer Kent may be reached at skent@njadvancemedia.com.

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Content: PEI

Nitroglycerin latest medication shortage

Nitroglycerin, which is used to treat heart pain, has been difficult to come by recently, joining a long list of drugs that have faced shortfalls in the last few years.

‘This isn’t the only medication that is shorted’

Nitroglycerin, which is used to treat heart pain, has been difficult to come by recently, joining a long list of drugs that have faced shortfalls in the last few years.

"It is frustrating because this isn't the only medication that is shorted," said Sheri Koshman, a cardiac pharmacist and professor in the cardiology division at the University of Alberta.

"There's all kinds of medication that is shorted all the time, and it's always this circle that goes round and round and round."

In recent months shortages of painkillers and antibiotics have also been reported.

Nitroglycerin can be used for long-term control and quick relief of heart pain, and it is the latter type where there is a shortage. Nitroglycerin dilates arteries and veins, so someone with blockages in their heart arteries can use it to open them up a little more.

For some people, nitroglycerine is an option they keep on hand but rarely use, and they will probably be OK during this shortage, said Koshman. The drug is safe to use up to a year after its expiry date, she said.

"We're telling people who have chest pain and are having to use their nitroglycerine regularly, and are perhaps running out, that they should probably see their physician to have their chest pain control reassessed," said Koshman.

"People that are needing it, and often, they should probably be reassessed by their health-care provider anyway."

The drug is really a pain treatment, and in that way not critical, she said. The important thing when experiencing heart pain is to sit down and rest. Giving your heart a break will also ease the pain.

If it doesn't go away, said Koshman, then you should seek emergency care. You may be having a heart attack.

With files from Island Morning

now

This report examines the scope, causes, and impacts of medication shortages between 2021-2024, with particular focus on life-saving medications for chronic conditions.

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Content: Lack of medicines in the Gaza Strip increases the suffering of Palestinians
The Palestinian Ministry of Health warned this week of a “shortage of medicines and medical consumables and a shortage of primary care items amounting to more than 60% of the basic list of primary care medicines. ”
An empty pharmacy in the Gaza Strip (Getty)
In Rafah pharmacies in the southern Gaza Strip, Mohammed Khader is searching for medicines for his father and sister, but he is facing extreme difficulty in finding them amid a severe shortage in the Strip due to the Israeli aggression for months, for which Israel is being tried before the International Court of Justice on charges of genocide, which has so far claimed the lives of some 30,000 martyrs, mostly children and women.
“This is the fifth pharmacy I am looking at, ” says the young man who fled to Rafah from Jabalia in the northern Gaza Strip, explaining,“ I found only one of three types (medicines) prescribed by the doctor, my father has a hole in the eardrum due to the shelling and he suffers all the time. ”
“My sister has chronic SLE and she needs four types of treatment, only one of which is available.
“Her health is deteriorating very badly, she is in great pain and we can ’ t do anything. ”
This week, the Palestinian Ministry of Health warned of a “shortage of medicines and medical consumables and a shortage of primary care items amounting to more than 60% of the basic list of primary care medicines. ”
The ministry said there were 350,000 people with chronic diseases without medication and warned of "serious health complications for patients".
In his pharmacy in Rafah, pharmacist Mohammed Sehwail says that what is happening is a “catastrophic period, ” explaining that“ not all types of drugs are available, especially for chronic diseases such as heart disease, stress, diabetes and cancer. ”
There is a shortage of children ’ s medicines, antibiotics and even painkillers. ”
"Even alternative medicines that may help in some cases have run out for months."
In another pharmacy, pharmacist Abdulhadi Dheer apologizes to a man who asks him about several types of medicines for Parkinson ’ s disease, while a woman leaves frustrated that no medicine has been found.
"The need for medicine has reached its peak, especially with the spread of diseases and epidemics due to overcrowding, malnutrition and living conditions," he said.
He points out that many come and “suffer from the symptoms of hepatitis, which is serious, but we feel helpless, there are no drugs, we cannot intervene without the guidance of doctors, even the alternatives to drugs have run out. ”
Some 1.4 million Palestinians, more than half of Gaza ’ s population, are crammed into Rafah amid desperate humanitarian and living conditions and a high risk of disease, according to the United Nations.
The Gaza Strip has been under an Israeli blockade since 2007, and this blockade has been tightened since the beginning of the Israeli aggression on the Gaza Strip, which receives little aid.
The Palestinian Ministry of Health warned that the accumulation of displaced people in the cold "has increased the spread of respiratory, skin and other infectious diseases," including hepatitis A.
In October, Israel launched a concentrated bombing campaign, followed by a massive ground offensive in the Strip, killing 28,663 people in the Gaza Strip, the majority of them women and children, according to the Palestinian Ministry of Health.
In the west of Rafah, more than 200 people stand in line in front of the pharmacy of the Kuwaiti hospital, waiting for their turn, carrying prescriptions and hoping to obtain the required medicines.
Jihan al-Quqa, displaced from Khan Younis, who has come since early morning, complains: “We stand for hours to get a pill.
They give us a pill. There are no antibiotics, no treatments.
The children are sick and the elderly. ”
“My husband has diabetes and his leg is swollen but we can ’ t get medicine for him.
Doctors say he has clogged veins because he doesn ’ t take medication. ”
Abdallah al-Haj, who had his leg amputated, sits in a wheelchair and laments, “There is no pharmacy in Rafah that has pain relief for me to sleep at night. ”
Months after the war broke out in October, Gaza ’ s health system appears to have collapsed.
According to the UN, there are no fully operational hospitals in Gaza, and only 13 of the 36 medical facilities across the Strip are operating at limited capacity.
On Wednesday, the health agency warned that hospitals in Gaza lacked “adequate supplies. ”
Doctors are forced to perform amputations due to a lack of means to treat patients and save their limbs, according to the World Health Organization ’ s local representative, Dr. Rick Peppercorn, from Gaza.
Nabil al-Othmani, 60, comes every day to ask about the medication he needs for epilepsy, but to no avail.
Trying to hold back his tears, he explains, “they tell me he ’ s not available at all. ”
Mohammad Yaghi, displaced from Gaza City, said: “We are slowly dying.
Because of the lack of medicines and treatments inside the city of Rafah. ”

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Breaking The Rules Of Healthcare: Overpaying For Drugs That Underachieve

Since this time last year, the U.S. Food and Drug Administration (FDA) has granted approvals for 42 new medications. The press releases for these drugs would lead a reasonable person to conclude that a pharmaceutical revolution is underway—that the drug industry is ushering in a brave new era of medical advances.

The truth is far less flattering. Despite enormous hype and dozens of new medications flooding the market each year, major pharmaceutical breakthroughs are exceedingly rare. The overwhelming majority of “blockbuster” drugs represent minimal (if any) improvement over existing treatments.

This is not because drug companies lack the scientific knowhow, research capabilities or dollars to deliver lifesaving medications.

Instead, drug-industry innovation has been stifled by an unwritten rule in healthcare; one that has guided nearly all pharmacological research and development (R&D) efforts of the 21st century.

The rule: Maximize drug profits by minimizing the risk of failure

In the previous century, before the term “wonder drug” was hyperbolically applied to every new FDA-approved medication on the market, drug companies almost always swung for the fences.

Consider the countless lives improved and saved by the true wonder drugs of the 20th-century.

Like insulin, discovered in 1921 to treat diabetes. Or penicillin, the infection-fighting antibiotic derived from mold in 1928. Or mechlorethamine, a 1940s weapon of chemical warfare turned cancer-fighting agent now used in chemotherapy drugs. Or the life-saving psychiatric medication chlorpromazine, now known as Thorazine, created in 1951. Or birth control (approved by the FDA in 1960), or statins that reduce heart-disease (like Lipitor, patented in 1985) or the HIV/AIDS treatment zidovudine (better known as AZT, 1987).

For each of these medications, the research and development (R&D) process was intense and time-consuming. The go-to-market costs were massive with the potential to bankrupt the underwriting drug companies involved.

But despite the expenses and risks, pharmaceutical leaders were driven then by an intrinsic desire to save lives. As George Merck put it in 1950 near the end of his 25-year run as Merck CEO: “We try never to forget that medicine is for the people. It is not for the profits. The profits follow.”

In the 1980s, that outlook shifted. Newly elected president Ronald Reagan pulled back government regulations, which sent the stock market soaring. Pharmaceutical shares skyrocketed more than 950% over the next 12 years.

By the 1990s, outsized CEO salaries and exorbitant drug prices had become the norm. The focus of the industry swung from saving lives to increasing shareholder value. Drug companies wanted to maximize prices while minimizing drug-development risks. They succeeded, and drug spending in the United States took off.

To spotlight the difference, consider that from 1960 to 1980 prescription drug sales remained fairly static as a percent of U.S. gross domestic product, consuming just 5% of all medical costs. Between 1980 and 2000, however, sales tripled. Today, prescription drug expenditures exceed $460 billion a year, accounting for 16.7% of all healthcare dollars spent.

The smoke and mirrors of drug pricing

Pharma leaders love to trumpet how expensive and time-consuming it is to bring a new drug to market. They collectively assert that ever-rising prices are needed to “cover accelerated investment in researching and developing new and better medications to protect Americans.”

That message has found a receptive audience among patients. Today, 68% of Americans believe that the cost of R&D is “a major contributing factor” to high drug prices.

The data tell a different story about where the money goes. One report found that 9 of 10 top drugmakers spend billions more on marketing than R&D. Another investigation noted that 80 cents of every $1 in prescription drug sales go to something other than R&D—be it profit, overhead, taxes, etc.

To be clear: Drug companies are not struggling to make ends meet or afford the cost of R&D. In fact, a 2019 analysis found that drugmakers could afford to lose $1 trillion in sales and still be the nation’s most profitable industry sector.

Maximizing revenue by minimizing risk

Two recent FDA approvals—Aduhelm, the first new Alzheimer’s medication in over two decades, and Trodelvy, a targeted treatment for aggressive breast cancer—demonstrate that drugmakers aren’t living up to their potential, despite the high prices and industry hype.

The companies behind Aduhelm and Trodelvy have issued a combined total of 70 press releases (34 from Biogen and 36 from Gilead) about their respective flagship drugs.

Notwithstanding the sheer quantity of promotion, neither drug will have a meaningfully positive impact on the lives of people with Alzheimer’s or breast cancer.

Look at Aduhelm. Two years before its approval, Biogen halted testing amid inconclusive and concerning results. In trials, the drug wasn’t shown to preserve intellectual function for patients. But rather than abandoning the medication or pausing to invest in additional R&D, the company filed for accelerated approval, which the FDA granted against the cautions and protests of its scientific advisory committee.

Upon approval, Aduhelm was projected to earn upward of $112 billion in annual sales with an initial price tag of $56,000 (five times greater than its estimated value)—a maximal profit projection for a drug with minimal value. This controversial drug and its accelerated pathway to approval have congress taking a closer look at the FDA. And for good reason. Since 1992, nearly half (112) of the 253 drugs given speedy approval have not been proven to extend longevity or improve quality of life.

And then there’s Trodelvy, a key drug in Gilead’s oncology portfolio. It was invented by Immunomedics, Inc., which Gilead purchased for $21 billion (one of more than 30 cancer drugs Gilead has acquired in the past five years).

Priced at over $2,200 per vial, a 21-day cycle of the new breast-cancer treatment costs $16,000 and contributed to an 11% revenue increase for Gilead in 2021 (leading to a $19 million bonus for the company’s CEO).

So, is Trodelvy worth the price? A company press release boasts a 49% reduction in the risk of death for patients who take the drug.

That figure is misleading at best. In studies, the medication extended median overall survival to 11.8 months compared to 6.9 months in the control group. The “statistically significant survival benefit” noted in the press release makes it sound as if patients taking the drug beat their cancer. In reality, they died less than five months later than patients who took standard chemotherapy.

When we zoom out and look at the 90-some new oncology drugs approved by the FDA this century, the average gain in life expectancy is a mere 73 days. Much of that time is spent in pain, dealing with debilitating side effects while being isolated from loved ones.

By following the rule of maximizing profits at minimal risk, pharmaceutical companies now routinely price and promote minimally effective drugs as if they were lifesaving medications.

Even the highly effective Covid-19 vaccines—the most celebrated innovation of the 21st century—were brought to market with minimal risk. The federal government paid for much of the underlying development costs through decades of NIH-funded research and minimized the risks to companies by fronting $18 billion as part of “Operation Warp Speed.”

Breaking the drug-industry’s unwritten rule

For drug companies, the lure of charging high prices ($2.1 million in one case) and generating huge profits (more than any other industry sector) distorts research priorities. As a result, pharmaceutical companies ignore many of the biggest areas of clinical need.

Consider antibiotics, a drug category that remains extremely under-researched and underfunded. Public health officials agree that antibiotic resistance undermines our entire modern medical system. Nationwide, drug-resistant bugs are becoming a growing threat, putting millions of lives at risk. That is, unless drug companies can discover the next generation of treatments.

But there’s a problem: Antibiotics are usually prescribed for a short 10- to 14-day course, generating only a tiny profit. Thus, identifying a new class of antibiotics is (financially) risky and nowhere as profitable as the drugs currently garnering the most interest—like cancer drugs, which can be priced at $120,000 to $150,000 a year regardless of efficacy.

Right now, more than 600 cancer drugs are being tested for clinical use. Meanwhile, there are no breakthrough antibiotics on the horizon.

For the past two decades, life expectancy in the United States has stalled. Our nation needs better, safer, more effective medications. But drug companies won’t develop them until the industry inverts its focus: not on minimizing risk but on maximizing its impact on human lives.

Americans won’t be able to afford those drugs until another rule of the drug industry is broken: the rule governing how drug companies price their newest medications. That will be the focal point of the next article in the Breaking The Rules Of Healthcare series.

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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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The analysis reveals systemic vulnerabilities in global pharmaceutical supply chains that directly impact patient care and require immediate attention.

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Content: Protectionism

Where's My Stuff?

Supply chains are struggling, but they're not as fragile as you think.

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Americans can be forgiven for thinking that every critical system we rely on is breaking down. The country—nay, the globe—has endured years of social, political, environmental, and epidemiological upheaval. Pick your shock: COVID-19, wildfires, George Floyd protests, climate change, January 6. They all seem like harbingers of a chaotic future.

But backlogs in Pottery Barn orders are when shit gets real.

From Bosch dishwashers to bucatini to chicken wings to pipette tips, the past year has seen a raft of press coverage about delays, price spikes, and other disruptions to the production and shipment of goods to the United States. Strains in the global supply chain caused semiconductor shortages and big price increases for used cars. Toyota, Ford, and General Motors have all scaled back production in recent months because of the dearth of computer chips. When the container ship Ever Given temporarily ran aground in the Suez Canal, the Financial Times asserted that the accident showed "the inherent fragility of tightly stretched global supply chains at the very moment when they are already being buffeted by a pandemic and in an era when the philosophical underpinnings of global trade are being challenged."

Journalists aren't the only folks freaking out. Less than six weeks into his term, President Joe Biden issued an executive order mandating that eight cabinet departments examine the resilience of U.S. supply chains, warning that "pandemics and other biological threats, cyber-attacks, climate shocks and extreme weather events, terrorist attacks, geopolitical and economic competition, and other conditions can reduce critical manufacturing capacity and the availability and integrity of critical goods, products, and services." More recently, Biden has floated multiple policy responses, including using the National Guard to untangle snarled supply chains.

The administration's concern about global supply chains fits in with the political elite's larger ideological pivot away from trade liberalization and toward a more mercantilist posture. Indeed, this is the area where the Biden and Trump administrations sound the most similar. Biden's U.S. trade representative, Katherine Tai, stated in a congressional hearing that trade liberalization and tariff reductions were no longer her office's principal goals. In June, Biden's National Economic Council director, Brian Deese, declared that "resilient supply chains must be at the center of a 21st century industrial strategy." One of Biden's senior directors at the National Security Council has told me that "the U.S. is not a trade-dependent nation." Another administration official questioned to me whether the notion of comparative advantage in trade still exists. Never one to be outdone in policy freakouts, Sen. Josh Hawley (R–Mo.) has introduced a bill requiring more than half the value-added of any critical good to be domestically sourced.

The recent convulsions in global supply chains do highlight ways the globalization of the past decade differs from the idealized models taught in introductory economics courses. Globalization has produced far more market concentration than would have been expected a generation ago. The tripling of the Baltic Dry Index (which measures the cost of shipping dry goods such as coal or steel between ports) and the quintupling of U.S.-China container shipping rates over the past year demonstrate that frictionless markets do not exist. Rising geopolitical tensions between the United States and China reveal the ways that great power competition will complicate cross-border exchange. And the pandemic showed how the global economy can be buffeted by shocks that textbooks typically do not discuss.

A closer look at global value chains reveals ways that both public-sector and private-sector actors have prioritized short-term efficiency at the expense of long-term resilience. But it also reveals a mismatch between a lot of overheated political rhetoric and an actual understanding of how the global economy works. Many of the past year's issues are temporary—and when it comes to strained global supply chains, globalization is more often the solution than the problem.

When Ford completed its massive River Rouge plant in 1928, it created a factory that controlled every facet of car production, including its own steel mill. Trade volume was high during this era, but very few intermediate goods crossed borders. In the time since then, the industrial organization of production has changed a wee bit.

Whereas trade a century ago was primarily in finished goods, manufacturing now has disaggregated itself into myriad chains of subcontractors. As one MIT Sloan Management Review article summarized the phenomenon, we have a "deeper tiering of supply chains whereby suppliers draw upon their suppliers who in turn draw on their own networks of suppliers in multistage production networks."

Why did this happen? The end of the Cold War eliminated most geopolitical concerns about where to locate production facilities. Basic trade theory meant an awful lot of facilities expanded in China, the low-cost manufacturing locale. The reduction of transportation and communication costs made it easier for production to be disaggregated and managed at a distance. "Just-in-time" manufacturing encouraged companies to hold minimal inventories and count on suppliers to respond quickly to fluctuations in consumer demand. Management consultants stressed the efficiency of offshore outsourcing.

The most widely cited example of the globalized supply chain is Apple's iPhone. Most people know that the iPhone is manufactured in China and exported to the United States. What is less well known is that China plays only a minor role in the creation of its added value. The iPhone's flash drive comes from the Japanese firm Toshiba. Samsung, a South Korean firm, provides the application processor. A German company provides the camera module, and a U.S. subcontractor provides the Bluetooth application. All of these parts are then assembled by a Taiwanese firm, Foxconn, with operations in Shenzhen, China.

The management consultants were right about the efficiency. While productivity in the service sector stagnated after the turn of the century, manufacturing productivity continued to soar.

The political economy advantages were also apparent after the collapse of Lehman Brothers. The last time a financial shock of that magnitude hit, the trade wars of the Great Depression began. 2008 was different. A World Bank study examined trade restrictions immediately after 2008 and found that "vertical specialization" was the most powerful economic factor that limited tariff increases. The more a country's economy was enmeshed in global supply chains, the less likely it was to raise barriers to trade. Global supply chains help explain why the Great Recession did not lead to trade wars like those of the Great Depression.

So these global value chains seemed like an unalloyed good. And then the 2010s happened.

As global supply chains grew more and more complex, there were signs of trouble on the horizon. In 2011, the Chao Phraya River floods in Thailand severely but temporarily constricted production of hard disk drives, because close to half of global output was sourced from Thailand. In 2017, U.S. hospitals faced an acute shortage of IV bags after Hurricane Maria knocked out a key production facility in Puerto Rico.

The 2011 earthquake and tsunami that hit Fukushima in Japan affected key nodes in global manufacturing. Some firms suspended sales of cars in certain colors because key ingredients were stored near Fukushima and inaccessible. An iPhone designer warned The New York Times that "there are all kinds of little specialized parts without second sources, like connectors, speakers, microphones, batteries and sensors that don't get the love they deserve. Many are from Japan."

These supply chain hiccups highlighted one underanticipated phenomenon of globalization: Rather than strengthen market competition, it strengthened market concentration. Consumer-facing firms from Walmart to Ford to Apple to Home Depot stressed cost minimization ubër alles. Firms that excelled at efficiently producing one part became near-monopolists for that component. This is how Taiwan Semiconductor Manufacturing Company (TSMC) became the dominant global supplier of customized semiconductor chips. Other chipmakers focused on design, subcontracting to the Taiwanese firm for the physical production. As TSMC accrued comparative advantages in chip production, even established competitors such as Intel struggled.

The return of geopolitical competition has also flummoxed producers. China is a critical node in almost every global value chain. Over the last decade, as Xi Jinping has consolidated his power, the Chinese state has taken a number of steps that have raised hackles in Western capitals. Some of these, such as the Belt and Road Initiative, have been overhyped. Others, such as the subjugation of the Uyghurs, repression in Hong Kong, increasing control over United Nations agencies, and the expansion of China's nuclear arsenal, have not. Xi's "wolf warrior diplomacy" has triggered evaluations in the United States, Europe, and Pacific Rim about just how vulnerable their economies are to disruptions from Chinese suppliers. The 2010 rare earth embargo on Japan in response to a territorial dispute in the East China Sea offered a warning about how China could weaponize the interdependence of global value chains; Huawei's dominance in 5G offered another. Erratic U.S. policies during the Trump administration served in turn as a warning about how Western governments could disrupt global value chains.

Finally, the COVID-19 pandemic exacerbated the problems of both market concentration and political whimsy. As China reeled from the pandemic's first wave, there were disruptions across the global economy. China exercised state power to seize domestically produced personal protective equipment and other medical supplies; the United States soon reciprocated. According to Global Trade Alert, 157 export controls on medical supplies and medicines were put in place across 86 jurisdictions in the first six months of the pandemic. U.S. leaders expressed concerns about vulnerability to China weaponizing its role in medical supply chains. So did journalists: In May 2021, 60 Minutes warned that "COVID showed that the global supply chain of chips is fragile." The Washington Post concurred: "The pandemic has exposed fragile global supply chains across multiple continents."

Countries exercised vaccine nationalism, stunting global immunization against COVID-19, which in turn facilitated the development of more dangerous variants of the novel coronavirus. The delta variant has penetrated Chinese port facilities, Malaysian chip factories, and Bangladeshi textile plants, leading to periodic shutdowns that have spiked container shipping prices and lengthened order backlogs.

Throughout all this, producers seemed to be stuck in quicksand. The past decade has not been shy in signaling to firms that there might be risks to increasingly disaggregated global supply chains. If natural disasters, pandemics, and geopolitical tensions were not enough, now management consultants are piling on. The same consultants who urged offshoring a generation ago are now telling firms to retrench from globalized supply chains. But most firms do not seem terrifically interested in changing their practices. Multinational corporations like Apple have not altered their supply chains in response to political pressure. Whether one looks at business surveys or journalistic accounts, the results are the same: Most U.S. firms do not plan on moving their supply chains away from China.

A world in which the distribution of goods is held up due to constant supply chain disruptions seems less than ideal. What can be done about it?

One thing that would be great is if everyone would acknowledge that a lot of the issues with global value chains right now have to do with demand more than supply.

When the pandemic began, there was an immediate and acute contraction of demand. Producers assumed that this would be the new normal and reduced their output. They were mistaken. The combination of emergency COVID-19 relief and the work-from-home phenomenon led to a resurgence of demand. The affluent class had considerable sums of disposable income. The pandemic made spending on services a less viable option, so instead they spent it on stuff: cars, furniture, home office equipment, gaming systems, house renovations, and so forth. The shortage of semiconductor chips was caused by the unexpected twin rebounds in demand for cars and consumer electronics. As one Federal Reserve analysis explained, "the pause in demand was much shorter and the rebound in demand was much stronger than anticipated." These demand surges surprised suppliers and led to the production bottlenecks that are currently seizing up Pottery Barn orders.

While demand has been stronger than expected, supply in critical sectors coped better than expected. The predicted pandemic breakdowns in supply chains for food and medical supplies proved to be overstated. Surveys of logistical firms last year revealed that the pandemic had minimal effects on their operational capabilities. Even when it came to medicines and personal protective equipment, there were only minor disruptions after the initial shock in March 2020. Claims that the global supply chain in medical products rendered states vulnerable to weaponized interdependence proved to be wildly exaggerated. The pandemic affected service sectors such as tourism far more severely than any manufacturing sector. Indeed, Slate's Jordan Weissmann pointed out recently that "imports were up 5 percent year-over-year in September, and up 17 percent compared with the same time in 2019." This happened despite the decline in air passenger traffic, which restricted yet another means of shipping goods by air. Supply has increased—it's just that demand has surged even more.

The private sector is responding to market signals by ramping up production and ensuring multiple supply lines. Intel, Samsung, and TSMC are all spending tens of billions of dollars to build new chip foundries in the United States. Skyrocketing shipping prices are incentivizing additional construction of new container ships. The Wall Street Journal reports that in the first five months of 2021, there were nearly twice as many orders for new container ships as there were in all of 2019 and 2020 combined. To ensure holiday inventory, large retailers like Walmart and Home Depot have chartered their own container ships. Container shipping rates have already started to decline from September peaks.

But these capital investments designed to boost resilience will take years to kick in. This time lag is one reason private-sector actors have been so slow to invest in resilient supply chains in the past. If disruptions are expected to be temporary, such investments might seem like overreactions. Given the billions of dollars at stake, this sort of risk aversion is unfortunate but understandable.

Long-term investments in resilience make some sense, but short-term investments in robustness make even more sense. Resilience is the ability to adapt in response to permanent shocks to the system. Robustness is the ability to maintain output levels in response to a short-term hit. The most obvious way that firms can enhance their robustness is to warehouse supplies of key components. Car manufacturers, for example, are pledging to ramp up their inventories of critical components to ensure a more reliable production stream.

Yet the auto sector appears to be the exception and not the rule in bolstering inventories. For most firms, increasing reserves of component parts is an expensive proposition. To a corporation, holding inventory is like holding cash: Why sit on an asset that yields no rate of return? Lean manufacturing was popular in the first place because it boosted profits.

Even as semiconductors have grown scarce, chipmakers and chip customers have battled over which firms will shoulder the costs of carrying greater inventory. Under the just-in-time system, the chipmakers had held the inventory. As one semiconductor CEO said earlier this year, the shortage has shifted the balance of power: "If they expect the semiconductor [suppliers] to be the bank, to keep having a big working capital to support them, they can forget it."

Bottlenecks in the global supply chain threaten the macroeconomic and microeconomic health of the United States. On the macro side, supply chain issues are driving fears of inflation; if not brought under control, this could cause the Fed to prematurely raise interest rates. A related problem is consumer panic over rumored shortages. See, for example, the effect of the ransomware attack on Colonial Pipeline—drivers panicked and went to gas stations to top off their tanks, temporarily worsening the problem.

On the micro side, the high price of inventories and shipping imperils market competition. Supply risks privilege larger firms over small and medium enterprises. Multinational corporations have the capacity to make large-scale investments in resilience and robustness. They are also able to use their market power to ensure continued access to scarce container billets in ships; your local bodega, by contrast, is unable to charter an entire container ship. The more stretched the global supply chain, the more sectors that look like monopolies rather than a competitive marketplace.

When it comes to fixes, there has been a surplus of really dumb ideas about what the government could do. Hawley's idea of essentially nationalizing supply chains stands out as the dumbest. Such a move would take well more than the three-year window he proposes to execute. Prices would permanently rise due to new inefficiencies. The opportunities for rent-seeking are legion; every sector would be lobbying Washington that what they produce is "critical." It is also worth remembering that Hawley's go-to policies of protectionism and immigration restriction shoulder much of the blame for the lack of truck drivers that have contributed to delivery delays.

The Biden administration's responses have run the gamut. White House Press Secretary Jen Psaki tried to laugh it all away by reducing the issue to "the tragedy of the treadmill that's delayed." That will not play well with a country used to just-in-time delivery and trying to move past the pandemic. Nor will Biden's proposal to open the port of Los Angeles 24/7 have much of an effect. While ports are currently jammed, there are also bottlenecks in railroad cars and truck drivers—both of which are issues that predated the pandemic. Even if the port gets unstuck, the traffic jam will just migrate to America's railroads and highways.

Looking at manufacturing more generally, some firms have acknowledged that they were unaware of the geographic distribution of their suppliers prior to the pandemic. This is one area where the Biden administration's efforts to collect data on supply chains could be useful.

If the federal government can identify (or even stock) priority components that would affect multiple sectors, those strategic reserves could theoretically bolster the robustness of the U.S. economy. But not if such investments become a stalking horse for protectionism.

All of the evidence of the past year suggests that globalization helps economies recover more quickly from supply chain difficulties than aggressive efforts at homeshoring. This is because most shocks are localized, and access to global value chains facilitates recovery more quickly. Indeed, protectionism is partly to blame for the current mess. As the Cato Institute's Scott Lincicome recently noted, the Jones Act, which mandates use of U.S.-built, crewed, and flagged ships to move cargo from one U.S. port to another, has raised the costs of coastwise shipping, putting even more pressure on truck and train transport.

Unsurprisingly, U.S. producers seeking relief from skyrocketing shipping rates have asked the Biden administration to reduce tariffs. Protectionism isn't the solution to these breakdowns in our supply chains; it's part of the problem.

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3 Undervalued Pharma Stocks Worth Buying

IPSEY – With the growing prevalence of chronic diseases, the adoption of advanced digital technologies, and new drug discoveries, the pharmaceutical industry is set to witness significant growth this year and beyond. Thus, it could be wise to invest in quality pharma stocks Ipsen (IPSEY), Supernus (SUPN), and Kamada (KMDA), which are currently trading at a discount. Continue reading….

The pharmaceutical industry is well-positioned to experience substantial growth in the foreseeable years, thanks to the escalating incidence of chronic diseases, widespread adoption of new technologies, and relentless R&D in the space.

Given the industry tailwinds, it seems wise to invest in fundamentally sound pharma stocks Ipsen S.A. (IPSEY), Supernus Pharmaceuticals, Inc. (SUPN), and Kamada Ltd. (KMDA), currently trading at discounted valuations, for potential gains.

With its swift vaccine development, life-saving treatments, and unwavering commitment to research and development (R&D), the pharma industry has an irreplaceable role in fortifying global health.

Over the past two decades, the pharmaceutical industry has grown remarkably, with global revenues reaching $1.48 trillion in 2022. The increasing prevalence of chronic diseases such as cancer, diabetes, and heart disease globally has also substantially heightened the need for innovative and advanced pharmaceuticals and treatments.

Furthermore, the industry is experiencing a rapid transformation with the widespread adoption of advanced digital platforms, big data analytics, and Artificial Intelligence (AI). These digital technologies are revolutionizing critical and labor-intensive processes within the industry, allowing for greater efficiency and streamlining of operations.

Such technologies are also extensively employed for drug discovery and development, drug production, smart process automation, and predictive maintenance optimization. According to a report by Polaris Market Research, the global e-pharmacy market size is projected to reach $371.25 billion, growing at a 19.4% CAGR.

Given the industry’s promising growth prospects, it could be wise to scoop up shares of discounted and quality pharma stocks IPSEY, SUPN, and KMDA that have the potential to yield significant returns.

Let’s delve into the fundamentals of the featured stocks.

Ipsen S.A. (IPSEY)

Based in Boulogne-Billancourt, France, IPSEY is a biopharmaceutical company specializing in oncology, neuroscience, and rare diseases. It operates through two segments, Specialty Care and Consumer Healthcare. The company also excels in neurotoxin research.

On March 3, IPSEY completed the acquisition of Albireo Pharma, Inc., a leading innovator in bile-acid modulators that treat rare liver conditions. The acquisition is anticipated to strengthen IPSEY’s Rare Disease portfolio, offering promising therapeutics for pediatric and adult rare cholestatic-liver diseases and enhancing the company’s scientific and commercial capabilities.

On February 15, IPSEY, Université de Montréal, and IRICoR announced that IPSEY had exercised its option to exclusively acquire rights to a pre-clinical stage program with potential oncology applications. The company would now take on all global development activities and commercialization of the drug candidate.

IPSEY, Université de Montréal, and IRICoR also announced plans to expand their strategic partnership by entering into a new multi-year collaboration and option agreement for two discovery-stage programs in oncology. Such expansion initiatives are expected to enhance IPSEY’s position in the oncology sector.

In terms of forward EV/Sales, IPSEY is trading at 2.74x, 28.1% lower than the industry average of 3.81x. Its forward EV/EBITDA multiple of 8.00 is 38.7% lower than the industry average of 13.04. In addition, IPSEY’s forward Price/Sales of 2.87x is 34.9% lower than the industry average of 4.40x.

On April 27, IPSEY presented its sales performance for the first quarter of fiscal 2023 that ended March 31, 2023. The company’s total sales increased 7.8% year-over-year to €741.90 million ($792.50 million) for the quarter.

IPSEY’s sales during the fiscal year that ended December 31, 2022, increased 14.4% year-over-year to €3.03 billion ($3.23 billion). Its core operating income rose 13.5% from the year-ago value to €1.12 billion ($1.19 million).

The company’s core consolidated net profit grew 17.9% year-over-year to €872.40 million ($931.90 million), and its core EPS was €10.51, up 18.4% year-over-year.

The consensus revenue estimate of $3.48 billion for the fiscal year (ending December 2023) reflects a 7% year-over-year improvement. Likewise, the consensus revenue estimate of $3.65 billion for the next fiscal year (ending December 2024) indicates a 5.1% rise year-over-year. Moreover, the company topped the consensus revenue estimates in all four trailing quarters, which is impressive.

Shares of IPSEY have gained 20.1% over the past year to close the last trading session at $29.72.

IPSEY’s solid fundamentals are apparent in its POWR Ratings. The stock has an overall rating of B, equating to Buy in our proprietary rating system. The POWR Ratings are calculated by considering 118 different factors, each weighted to an optimal degree.

IPSEY has an A grade for Value and Stability and a B for Quality. It is ranked #20 in the 168-stock Medical – Pharmaceuticals industry.

In addition to the POWR Ratings I’ve just highlighted, you can see IPSEY’s ratings for Growth, Momentum, and Sentiment here.

Supernus Pharmaceuticals, Inc. (SUPN)

SUPN is a biopharmaceutical company that develops and markets products for Central Nervous System (CNS) diseases. Its diverse neuroscience portfolio includes treatments for epilepsy, migraine, Attention Deficit Hyperactivity Disorder (ADHD), and hypomobility in Parkinson’s Disease (PD), among others.

On February 14, SUPN announced its agreement with UBS Bank (UBS) USA for a credit line, granting the company an uncommitted demand-secured line of credit of up to $150 million. This additional capital would empower SUPN to enhance its financial strength and support its growth objectives.

Jack Khattar, SUPN’s President and CEO, said, “We are pleased to further enhance the strength and flexibility of our balance sheet with this line of credit.”

In terms of forward non-GAAP EV/Sales, SUPN is trading at 3.49x, 8.6% lower than the industry average of 3.81x. Likewise, the stock’s forward Price/Sales multiple of 3.09 is 29.7% lower than the industry average of 4.40.

For the first quarter that ended March 31, 2023, SUPN’s revenues marginally increased year-over-year to $153.76 million. Its non-GAAP operating earnings rose 8.9% year-over-year to $30.50 million. Also, as of March 31, 2023, the company’s current assets stood at $883.34 million, compared to $734.15 million as of December 31, 2022.

Analysts expect SUPN’s revenue for the fiscal year ending (December 2024) to increase  9.7% year-over-year to $668.75 million. The consensus EPS estimate of $2.08 for the same period reflects a 58.1% growth year-over-year. Also, the company surpassed the consensus revenue and EPS estimates in three of the trailing four quarters.

The stock has gained 23.7% over the past year to close the last trading session at $34.59.

SUPN’s positive outlook is reflected in its POWR Ratings. The stock has an overall rating of B, translating to Buy in our proprietary rating system.

SUPN has an A grade for Value and a B for Momentum and Quality. It is ranked #22 out of 168 stocks within the Medical – Pharmaceuticals industry.

Click here to access additional SUPN ratings (Stability, Growth, and Sentiment).

Kamada Ltd. (KMDA)

Based in Rehovot, Israel, KMDA supplies plasma-derived protein therapeutics. Its segments include Proprietary Products and Distribution. The company’s portfolio encompasses treatments for immune thrombocytopenic purpura, hepatitis B prevention in transplants, varicella post-exposure, intravenous AATD, and more.

On May 16, KMDA announced Swissmedic’s marketing authorization for Glassia® in Switzerland to treat adults with clinically evident emphysema resulting from severe hereditary Alpha-1 antitrypsin deficiency. These advancements would broaden KMDA’s market presence and offer crucial treatment alternatives to patients in Switzerland.

KMDA’s CEO, Amir London, said, “Switzerland is the first European country to approve Glassia for AATD, representing a significant milestone for Kamada, in a market which is currently estimated to be over $15 million annually.”

Furthermore, on May 3, the company announced FDA approval for its application to manufacture CYTOGAM®, marking it as the third product authorized for production at its Israeli facility. By leveraging its portfolio of four FDA-approved IgGs, KMDA anticipates ongoing expansion from these crucial products in 2023 and beyond.

In terms of forward EV/Sales, KMDA is trading at 1.59x, 58.3% lower than the industry average of 3.81x. Also, the stock’s forward Price/Sales of 1.62x is 63.1% lower than the industry average of 4.40x.

For the fiscal first quarter that ended March 31, 2023, KMDA’s revenues increased 9.3% year-over-year to $30.71 million, and its gross profit grew 4.8% year-over-year to $11.84 million. In addition, the company’s operating income rose 17.5% from the prior year’s period to $289 million. Its adjusted EBITDA grew 16.5% year-over-year to $3.83 million.

Analysts expect KMDA’s revenue to increase 9% year-over-year to $154.14 million for the fiscal year ending December 2024. The company’s EPS for the same year is expected to grow 38.5% from the prior year to $0.18. The stock has gained 25.1% year-to-date to close the last trading session at $5.19.

KMDA’s robust outlook is apparent in its POWR Ratings. The stock has an overall rating of B, which translates to Buy in our proprietary rating system.

KMDA has an A grade for Growth, Value, and Sentiment. It has ranked #14 within the same industry.

Click here to access additional KMDA ratings for Stability, Quality, and Momentum.

What To Do Next?

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IPSEY shares were trading at $29.72 per share on Wednesday afternoon, up $0.05 (+0.17%). Year-to-date, IPSEY has gained 13.53%, versus a 12.07% rise in the benchmark S&P 500 index during the same period.

About the Author: Aanchal Sugandh

Aanchal's passion for financial markets drives her work as an investment analyst and journalist. She earned her bachelor's degree in finance and is pursuing the CFA program. She is proficient at assessing the long-term prospects of stocks with her fundamental analysis skills. Her goal is to help investors build portfolios with sustainable returns. More...

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## Scope of the Problem

### Global Impact
Medication shortages are a worldwide phenomenon affecting healthcare systems across all economic levels.

Title:

Content: Factory damaged by tornado Pfizer warns of supply disruptions for some drugs
Font Size:
Pfizer has warned that dozens of medicines it produces could be cut off as a result of tornado damage at its North Carolina plant.
Bloomberg reported that Pfizer issued an email notice to customers on Friday (July 21) that 65 products, including the local anesthetic lidocaine, the analgesic morphine and other basic hospital drugs, "may continue to be interrupted or new supply interruption in the near future."
According to the U.S. Food and Drug Administration (FDA), 46 of these products are already in short supply.
Last Wednesday ’ s tornado wreaked havoc at Pfizer ’ s plant in Rocky Mountain, North Carolina, where 8 percent of the injectable drugs used in U.S. hospitals are manufactured.
With the pharmaceutical giant ’ s huge market share, a record drug shortage could worsen further, raising concerns.
According to the Utah Service, the shortage of drugs in the United States has reached its highest level in nearly nine years, and stocks of 309 products, including cancer drugs, antibiotics and attention deficit hyperactivity disorder drugs, are in short supply.
Pfizer also said Friday that the damage at the North Carolina plant was concentrated in warehouses and production areas were not significantly affected, easing some concerns. The FDA has asked other drugmakers to increase production and is not expected to have a "significant impact on supply."
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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.

Reports from multiple countries including the United States, Egypt, Palestine, Lebanon, and India demonstrate that no nation is immune to this crisis.

The shortages affect essential medications across various therapeutic categories, creating widespread challenges for healthcare providers and patients.

Title:

Content: Nationwide Adderall shortage impacting area pharmacies in the Panhandle

Published: Oct. 19, 2022 at 5:07 PM CDT|Updated: 19 minutes ago

AMARILLO, Texas (KFDA) - The Food and Drug Administration has declared a nationwide Adderall shortage and the Panhandle is feeling the affects.

The FDA blames the shortage on manufacturing delays.

Health experts say a shortage in stimulant medications is actually not a rare occurrence.

“The amount of medication that is produced is limited and regulated by the government, so there have been other years where towards the end of the year in particular, we start to struggle with supply issues. In this case, however, while that does seem to be probably one of the contributing factors, the other issue we’re facing, at least what we’re hearing about it right now, is that the manufacturing delays have been an issue and some of that has been secondary to the labor shortages,” said Dr. Carolyn Lentsch-Parcells, pediatrician and assistant professor at Burnett School of Medicine at TCU.

Martin Tipton Pharmacy is being impacted by this shortage.

“We’re having to order from various manufacturers right now, not our normal manufactures just because we cannot get them from our normal ones,” said Mark Vogler, Martin Tipton Pharmacy.

Fortunately its patients have been able to get their needed medication, just a different brand.

Amarillo Pharmacy is also being impacted, saying the drug has been back ordered for the past two months.

The Amarillo Pharmaceutical Care Center at Texas Tech Physicians is also seeing a back order on one of the strengths of the drug.

“The drug company manufacturers short-acting and extended-release, for example. So, a pharmacist, in this situation, will work collaboratively with the patient’s provider to find an available strength and dosage to meet the patient’s needs until the original strength becomes available again,” said Amarillo Pharmaceutical Care Center at Texas Tech Physicians.

Dr. Lentsch-Parcells acknowledged this may be an uneasy time for those depending on Adderall, especially with the end of the semester and holidays approaching. She encourages you to reach out to your providers.

“There are various strategies that we will sometimes use to help our patients get the best care possible, while we are trying to ride out the shortage, so that might be changing dosage or using dosage forms that are available to replace their typical medication,” said Dr. Lentsch-Parcells

She emphasizes not to make any changes to your medications without speaking to your providers first.

Pharmacy chains, like CVS and Walgreens, both confirm they are seeing intermittent supply issues with the generic form of the drug.

### Affected Medications and Medical Supplies
Based on documented cases, the following categories have been significantly impacted:

- **Antibiotics**: Amoxicillin shortages