Drug Shortages
Sonya Collins
On any given day in the United States, there are shortages of some 300 different prescription medications. Shortages are not new, though they do seem to be grabbing more headlines in recent years as major international supply chain upsets, spawned by the COVID-19 pandemic and superstorms like Maria and Helene, seem to be increasingly commonplace.
When pharmacists in the United States are scrambling to find creative solutions to filling prescriptions for drugs in short supply, it may be hard to imagine that those same drugs could be plentiful just over the border in Canada. But that is often the case, according to a JAMA study by Tadrous and colleagues published online October 31, 2024.
“During big, shared supply chain issues, we found that the problem was 40% less likely to result in a decrease in supply in Canada than in the United States,” said Katherine Callaway-Kim, MPH, PhD, a postdoctoral scholar at University of Pittsburgh School of Medicine.
Land of plenty
The study authors compared the consequences of drug-related supply chain problems that occurred between 2017 and 2021 and affected both the United States and Canada. During this time, there were 104 reports of relevant supply chain problems. Within 12 months, nearly half of those supply chain problems led to drug shortages in the United States, while shortages only occurred after one-third of those issues in Canada.
“It does suggest that Canada is doing something right to prevent these big issues from impacting their national supply,” Callaway-Kim said.
Lessons from our neighbor to the north
While the study’s objective was not to identify the mechanism by which drug shortages are less likely in Canada, there are key differences between the United States and Canada that may drive disparities in drug supply.
First, news of a drug shortage may get out sooner in Canada than it does in the United States, which allows everyone impacted to take the earliest possible action.
“Canada was one of the first to fully mandate drug manufacturer reporting and is very proactive about it,” Callaway-Kim said. “At first glance, it actually looks like Canada has more shortages than the United States, but that’s because Canada has a more granular level of reporting.”
Furthermore, Health Canada, a Canadian federal agency that is similar to FDA, regularly convenes a task force comprised of representatives of all the partners in the drug supply chain, including all the major public payers, the major health systems, and the major drug wholesalers.
“As shortages happen, they can pull in the manufacturers and the private sector to have these conversations with them,” said Mina Tadrous, PharmD, PhD, an assistant professor at the University of Toronto Leslie Dan Faculty of Pharmacy. “They don’t have to reinvent it every time a shortage happens because that committee exists all the time and meets routinely.”
A call for global cooperation
That one country can experience a shortage while the other does not, in the face of the same supply chain disruption, shines a light on the need for global cooperation.
As supply chain issues persist, there’s a need for proactive measures that transcend borders to prevent drug shortages. Multiple countries can coordinate investment into specific active pharmaceutical ingredients and manufacturing sites and build these plans into trade agreements.
“We want to see countries talking to each other and coordinating, not taking drugs from each other in a way that then causes a shortage in another country,” Tadrous said.
In the face of a shortage, Tadrous said, countries should have a mechanism for quickly pivoting to import the drug or a pre-approved equivalent from elsewhere.
Finally, there’s a need for countries to continue to study each other’s policies and share best practices with one another in order to learn how to reduce the likelihood that a drug goes into shortage in the future.
“Because,” Tadrous said, “as every pharmacist knows, these shortages aren’t going away.” ■