Drug shortages are nothing new. They have been an ongoing and growing problem for decades in pharmacy practice but the COVID pandemic has tested the UK and European drug supply chains as never before.
Drugs are an essential part of patient care. None of us need to be convinced of the implications caused by shortages of drugs, even if they are short-term. Drug shortages can adversely affect therapy and compromise or delay medical procedures and frequently affect healthcare institutions, posing tough financial and logistical challenges.
The lack or unavailability of specific drugs such as chemotherapeutics, immunosuppressants, anaesthetics, anti-epileptics, drugs for the treatment of cytokine release syndrome, and even total parenteral nutrition, can have clinical consequences and a significant impact on the treatment of many patients.
The current unavailability of many drugs is apparent across all healthcare settings. The COVID-19 pandemic has highlighted many difficulties and has tested the UK and European drug supply chains like never before. Supplies of not only essential and life-saving drugs but also those commonly used in supportive care have been impacted. Currently, all hospital and community pharmacists are faced with the problem. On top of that, there is an increasing concern about the tremendous resources required to address these shortages as a result of having to purchase more expensive substitutes.
Not a new situation
Drug shortages are, however, nothing new. They have been an ongoing and growing problem for decades in pharmacy practice.
So, what causes these shortages? The reasons are multiple and complex, ranging from manufacturing problems, unexpected increases in demand (the COVID-19 pandemic falls in the latter category), disruption of drug-supply chains and industry quotas, to geopolitical developments.
Regardless of the cause, shortages are an immediate call to action for pharmacists to look for alternatives to ensure optimal treatment for their patients. We cannot deny that the impact on the pharmacy load is high. Whenever there is a new drug shortage, managing it becomes a pharmacy task that sometimes requires more than a full-time follow-up in many centres. Dedicated teams within the pharmacy undertake many efforts to assess shortages. Examples include developing and implementing appropriate strategies to overcome them, providing seamless, safe, and therapeutically equivalent drug therapy, preferably at a comparable cost, communicating the findings to all healthcare providers within the hospital, and adapting electronic prescription orders and correct invoicing.
Software systems enabling automatic extraction and follow-up are often efficient measures to cope with the daily pressure. Efforts are not only limited to pharmacy activities but might also involve patient allocation and patient cohorting strategies, directly affecting the tasks of the physician.
To stay up to date with current shortages, the European Medicines Agency (EMA) has created a shortages catalogue with information on (ongoing and resolved) specific shortages that affect, or are likely to affect, more than one EU Member state, where EMA has assessed the shortages and provided recommendations to patients and healthcare professionals across the EU (see www.ema.europa.eu/en/human-regulatory/post-authorisation/availability-medicines/shortages-catalogue).
As many drug shortages are dealt with at a national level, checking the relevant national registers in the EU and European Economic Area Member States with information on shortages in the individual countries or visiting the websites of the national authorities can be useful.
It is hard to predict the future, but it is possible that drug shortages will continue to be a healthcare issue and persistent supply interruptions will become more commonplace.
As pharmacists, we have unique skills in bridging drug shortages and must continue to ensure that we play an active, dynamic role in finding ways to manage these and mitigate their impact on our patients.