The coronavirus pandemic has increased the risk of shortages of several essential medicines. Raw materials for many key drugs, such as antibiotics and statins, are manufactured in China, where factories have been disrupted by efforts to contain the virus. Will this mean shortages for the NHS?
The drug supply chain relies on what are known as “active pharmaceutical ingredients” – the basic molecules used to make drugs. These raw materials are manufactured in China and then exported to India and other countries where they are formulated into tablets or injections, for sale worldwide. Indian companies procure 70% of their raw materials with ingredients from China, where manufacturing is cheap. The NHS imports 80-90% of its drugs supply from abroad, and 25% of its generic drugs from India.
At the height of the Chinese Covid-19 epidemic, Chinese factory production was stopped. Workers were quarantined and transport between factories was disrupted, so key raw materials weren’t produced. After supplies of Chinese raw materials ran out, companies in India and elsewhere could no longer produce and export the same volume of medicines.
In response to shortages, India decided to provide its people with essential medicines first. The country recently banned exports of key medicines such as antibiotics, statins and paracetamol. In the long-term, this could wreak havoc on the NHS supply line. Although some Chinese factories have reopened, it is unclear when production will be fully restored, or when India will lift its restrictions on drug exports.
In the short-term, as a result of no-deal Brexit planning, the NHS has a reserve supply of drugs to prevent shortages occurring. But these contingency plans won’t last for ever.
We have seen drug shortages in the past, albeit on a smaller scale. In 2008, after Chinese factories closed near Beijing for three weeks during the Olympic Games, there were shortages of raw materials. In 2019 an epidemic of swine flu in China depleted the global supply of heparin, an essential medicine to prevent heart attacks. In Puerto Rico, Hurricane Maria damaged another factory making heparin, which disrupted supplies of the drug in 2017.
The effects of coronavirus will last for months, and will expose the vulnerabilities of our drug supply chain. We need to apply new stress tests to the NHS drug supply chain. How will the NHS cope if Chinese supplies are continually disrupted? How will it be affected by disruptions to supplies of drugs from other countries, such as Italy? For each essential medicine, are there alternative suppliers in other countries? And are there alternative drugs that patients could take if one drug is no longer available? Stress tests were applied to the banking system after the financial crisis of 2008. Our supplies of medicines are equally important, and should be tested in similar ways.
Instead of relying on imports, we should re-evaluate the case for manufacturing more medicines in the UK. Britain has a long history of pharmaceutical development. During the second world war, Glaxo Laboratories in the UK manufactured 7.5 billion tablets of penicillin a year. Now, however, both the UK and US depend on supplies of penicillin from China.
Human trials for a coronavirus vaccine will begin in April – but before a vaccine is ready, we will need to ensure that key drugs to treat the symptoms of coronavirus are available for everyone who needs them. Pilot studies from France and the US suggest that hydroxychloroquine can lessen the severity of coronavirus infection. A clinical trial in Shanghai is currently evaluating whether pirfenidone could improve lung function for people with severe disease. More definitive clinical trial results of these and other drugs are expected in May and June.
These drugs are already being manufactured in other countries. But the acute worldwide demand for drugs to treat coronavirus could easily outstrip supply. In times of shortage, other countries could stockpile their supplies to treat their own people. Like India, they may be unwilling to export drugs to the UK.
Supply chains are only as strong as their weakest links. If new treatments for coronavirus emerge in the next few months, the UK can’t afford to be the last link in a vulnerable chain. The government has already requested that UK companies manufacture more ventilators and protective masks. It should do the same with the UK pharmaceutical industry, repurposing factories to produce drugs that help treat coronavirus and any other essential medicines at risk of shortage.
