There are three main factors that separate a healthy population from one riddled with disease: good food, clean water, and essential medicine.
While all medications serve a purpose, only some are considered essential. Essential medicines fulfill the highest public health priorities. The World Health Organization (WHO) has maintained a list of essential medicines since 1977. These medications are selected based on the prevalence of the diseases they treat, evidence of their efficacy and safety, and their cost-effectiveness. Due to their critical importance, essential medicines should be available at affordable costs in functioning health systems at all times.
The Public Health Risk
In August 2020, an executive order from then-President Donald Trump compelled the U.S. Food and Drug Administration (FDA) to check the nation’s stock of medical essentials for combating everything from emerging infectious diseases to biological and radiological threats.The audit uncovered an alarming lack of nearly 300 critical medicines—showing that national drug shortages were at an all-time high.
While the FDA managed to prevent a record number of drug shortages in 2021, gaps remain, leaving Americans vulnerable to threats that modern medicine should guard against. Short supplies affect emergency rooms and cancer treatments, and examples include both prescription medications and over-the-counter drugs.
The National Security Risk
Shortages of essential medicines have plagued the United States for years and have continued worsening despite repeated calls to action. From 2021 to 2022 alone, new shortages rose by nearly 30 percent.“These risks carry devastating, yet avoidable consequences for all Americans, including our military,” the report reads. “Until the federal government and industry strengthen efforts to jointly assess and address their underlying causes, drug shortages will remain a consistent health and national security risk.”
The report highlights a major kink in our poorly performing drug supply chain: an unhealthy over-reliance on foreign sources for both medications and the raw materials needed to make them.
There’s no mystery about how this problem took shape.
Like much of American manufacturing, American drug companies have increasingly outsourced their operations to overseas entities since the 1990s. Cheaper labor and fewer regulations make for a more attractive business environment.
A 2019 FDA analysis found that the lack of incentives for less profitable generic drugs regularly used in hospitals was a key factor.
While it may not be so lucrative to manufacture critical generic drugs, the result of our dwindling domestic production means longer supply chains with greater logistical challenges and less oversight.
Overseas Ties Bind US Medicine Supply
The “Short Supply” report found that the number of China-based drug manufacturers registered with the FDA more than doubled between 2010 and 2015. Estimates suggest that 90 to 95 percent of one essential drug group—generic sterile injectables for critical acute care in the United States—relies on starting materials from China and India.These overseas dependencies will make future shortages hard to predict and prevent. Because most of our drug manufacturing takes place overseas, neither the federal government nor the pharmaceutical industry has a clear view of how the shortages arise or when they begin.
The Senate committee called on Congress, the president, and the pharmaceutical industry to work together to make the whole process more visible, but doing so will take determined steps.
Bring Back Domestic Production: Experts
Although lawmakers have called for a more transparent supply chain for years, some experts say the fundamental fix is to bring drug manufacturing back home.Foreign drug manufacturing not only increases our risk of lacking medical necessities but also places a vital and sensitive commodity in the hands of an adversary, according to the Brookings Institute, a Washington-based public-policy think tank.
To bolster domestic capability, Brookings recommends incentives such as tax credits, loans, infrastructure investment, and production support for U.S. drug firms.
“Forty percent of our finished medications and eighty percent of their active ingredients are manufactured in China; and most of the manufacturing sites for medical countermeasures for use against biological, chemical, and radiation threats are located outside of the United States, mainly in China,” Ms. González-Colón said in a statement. “Strengthening the U.S. medical supply chain is not only an issue of economic development, it is essential to our national security.”