For anyone who relies on medication to treat a health condition, a shortage will be unwelcome. In some cases, for example cough and cold remedies, this will be a worrying inconvenience. But in others, such as HRT, diabetes drugs, antibiotics and antipsychotics, there are serious implications for health and wellbeing. In extreme circumstances the lack of a drug could pose a threat to life. Most recently the alarm has been raised in relation to riluzole, a medicine used by sufferers from motor neurone disease to delay ventilator dependence and prolong life.
Worryingly, the Motor Neurone Disease Association claims that concerns raised with the health secretary, Victoria Atkins, and her department, have not been properly dealt with. Riluzole’s manufacturer, Glenmark, has pointed to competing demands for limited stock of its active ingredient. That sufferers of such serious illnesses are facing these problems is obviously concerning. With around 100 medicines on a shortages list, the government appears under‑prepared and slow to act.
The UK is not alone in facing drug supply-chain challenges. This is a global issue, which has been rising up the agenda of EU states and the US as well. Rich western countries, along with much of the rest of the world, are heavily reliant on the pharmaceuticals manufacturing capacity of India and China for sufficient quantities of generic, off-patent drugs. During the pandemic the risks of this model became obvious when countries were forced to compete for vaccines, and India placed export restrictions on many items, including paracetamol.
Both the EU and US have responded with significant moves towards reshoring. France is building a paracetamol factory large enough to meet half of all European demand. Belgium has made the issue a theme of its EU presidency. Rules about state aid look set to be altered, and pharmaceuticals recategorised as a strategic industry like semiconductors. While European manufacturing will make supplies more secure, it is also expected to make drugs more expensive and reduce carbon emissions and other environmental damage associated with them.
Teams in the Department of Health and NHS England, and equivalent bodies in the devolved administrations, play a crucial role in overseeing the UK’s medicine supply. Thanks to stockpiling and other measures, departure from the single market did not lead to chaos. But Brexit has increased pressures. The fall in the value of the pound has made the UK a less attractive market. There is a balance to be struck between putting downward pressure on prices – which the NHS has historically been good at as a big purchaser – and incentivising suppliers. Current shortages suggest that the current system isn’t working well.
As well as day-to-day management, the UK needs a strategy. This should involve working with, rather than against, the EU on reshoring production in Europe. It should include plans for spikes in demand such as that seen for HRT, following a campaign around menopause symptoms and a shift in prescribing patterns. Shortages such as that affecting the type 2 diabetes drug Ozempic after it began to be prescribed for weight loss, should be anticipated even if they cannot be avoided. Poll after poll shows how much the public cares about healthcare. Workforce shortages and lack of investment are the biggest issues, but access to medicines is vital, too.