opinion | Why the shortage of children's medicines will not end (2023)

A friend was visiting family in England over Christmas and posted a photo on Instagram of pharmacy shelves lined with children's painkillers. Like many American parents, myself included, that bothered him.lack of painkillers for childrenYcertain formulations of antibiotics.

This shortage has continued into January, with parents on the brink of despair and US lawmakers on the brink of despair.linksand theOn the rightDemand accountability and responses from the pharmaceutical industry.

Many of the articles I had read on this topic were more focused on that.practical tips on what to doif you can't access the medicines your child needs in the short term, but my friend's post inspired me to investigate further. Specifically, I wanted to know: are these bottlenecks primarily an American problem? And, generally speaking, what is causing them? Are they occurring due to Covid-era supply chain disruptions or something else?

The quick and dirty answer: Drug shortages aren't just an American problem, it's not limited to children's drugs, and in some cases it became a problem before 2020.

Over the past year there have been stories of drug shortages inGermany,Haveand - despite those full shelves my friend found in London -the United Kingdom.And while it may seem like it's recent media coverage that suggests there are more shortages of children's medications than adult medications, a review of the current shortages and resolvedreportedThe Food and Drug Administration shows how widespread shortages can be and how many types of drugs are affected.

So what is going on? First, "our markets are really tuned to a certain level of demand," said Dr. Mariana Socal, an associate physician and scientist at the Johns Hopkins Bloomberg School of Public Health. So when there is an unexpected and growing demand like there has been for children's medicines in certain parts of the countrythe recent confluence of influenza, R.S.V. and covid, pharmaceutical companies and retailers are not prepared to react quickly.

This is combined withProduction outsourcingof most pharmaceutical agents in medicines, something that is associated withcurrent amoxicillin deficiency. Production of many of these active ingredients takes place in India and China, as well as in European Union countries, Socal noted. If there are delays in getting these compounds into the global supply chain, it can create shortages of important drugs, he said.

The maker of children's Tylenol and children's Motrin, Johnson & Johnson,said the timeThere is no shortage nationwide. But what's frustrating is that there's currently no efficient way to redistribute children's medications to parts of the country where supplies are low, Socal said. This is because our drug distribution is highly concentratedbetween only three wholesalers, and each has "its own way of allocating its inventory," he said.

As Dr. Joshua Sharfstein, a physician and associate dean of public health practice and community engagement at the Bloomberg School (and colleague at Socal), put it: “The system has evolved to be very efficient, but not very resilient. "They focus on doing what they can do at the lowest cost to their part of the chain. Companies at each stage do their thing, but they don't add capacity because it's expensive. They don't stick with big box stores because that would be expensive, too."

So, can anything be done to alleviate these bottlenecks? While the Consumer Healthcare Products Association said in Decemberopinionthat “C.H.P.A. member companies operate production facilities 24/7 to meet demand,” parents comment anecdotally.they still struggle to find the medicines they need, although that could improve in the coming months.

It could take years and a concerted effortSolve systemic problems. Darrell West, a senior fellow at the Brookings Institution, said the mix of supply chain challenges has been "an issue for decades." One thing we can do, he said, is to outsource some of the production of essential drugs so that the United States can "control its own destiny" and be less dependent on remote suppliers. We can also "nearshore" some of the production to Canada and Mexico or to the US territory of Puerto Rico, as Ezekiel Emanuel suggested in a statement.rehearsalpara el Washington Post.

"The cost will go up because it's more expensive to make in the United States," West said. "We have detailed health, safety and environmental regulations." But "it's a cost worth paying because it puts us in a stronger position to manage supply and demand." , he said.

However, onshoring may not be a panacea, as we saw inthe baby food shortage of 2022, when the closure of a single American factory caused chaos. "My data really confirms that onshoring is not a panacea for mitigating supply chain problems," Socal said.

Both she and West said we need more producer diversification, and West said there was reason to be optimistic things would get better with time: "The good news is that there are a number of US companies that have seen the problems in the global supply chain and they are moving their production capacity to the US or neighboring countries. It is a longer-term challenge. We will not be able to solve all these problems overnight."

In the meantime, we may continue to face drug shortages, which is especially worrying for our children. Sterling Elliott, a clinical pharmacist and assistant professor of orthopedic surgery at Northwestern University Feinberg School of Medicine, who described the drug shortage in the United States as "a very ugly scenario', which has been going on for years, said the shortage has risen in our awareness because it is poignantly horrifying for parents to see young children in danger. "There is no worse feeling on the planet as a parent than feeling like I can't help my child," she said. As a matter of fact.

small victories

Being a parent can be an ordeal. Let's celebrate small victories.

Credit for this win is due 100% to my first grade son's teacher, who taught the kids this ditty to the tune of Ghostbusters: "When there's something strange / When you're reading a book / What are you going to do?" to do?" Take a closer look!" She made me laugh so hard.

– Ann Wang, Providence, Rhode Island

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