Over the past year there has been a consistent stream of drug supply issues in the UK and internationally. Recent figures show more than 111 products have been affected in the UK alone. This is more than double the figure recorded for 2022.
These supply issues have led to shortages of numerous products. While global scarcity of Ozempic and Wegovy have received much attention, many other drugs in the UK have been in short supply – including drugs used to manage type 2 diabetes, ADHD and menopause symptoms.
These shortages have affected millions of people across the globe and in the UK – with many finding it more difficult in the past year to get their regular prescriptions dispensed.
This may have many wondering why 2023 has been a year characterised by so many drug shortages – and whether the situation will be similar in 2024.
Causes of shortages
There are four main reasons for the current global drug shortages.
Manufacturing issues are the most commonly cited cause of drug shortages. According to a report from 2022, 60% of global medicine shortages were due to manufacturing problems. This is likely to have been the same in 2023.
Pharmaceuticals are manufactured to tightly monitored quality specifications. As such, developing, expanding and moving production are difficult processes. Shortages of materials and halting drug production to resolve quality issues and technical faults can also contribute to shortages.
Shortages of a range of pharmaceutical products this year have also been linked to an increase in patient demand. This has been cited as the primary cause of shortages of hormone replacement therapy (HRT), ADHD medicines, Ozempic (used to treat diabetes) and Wegovy (which contains the same active ingredient as Ozempic, but is licensed for weight loss) this year. Ozempic is a particularly good example of how a rapid increase in demand can have serious consequences on supply chains.
Ozempic is only licensed to treat type 2 diabetes. But it became popular via social media because of off-label use to aid in weight loss. Increased use, licensed and unlicensed (off-label), had such a significant affect on supply that doctors in many countries were advised not to begin new patients on the drug.
This also meant patients who required Ozempic could not access it. It even led to black market selling and fake products, which had questionable safety.
Increases in demand for some products have also been fuelled by seasonal factors. Last year’s strep A outbreak caused an uptick in antibiotic prescriptions. The resulting shortages have still lasted into this year.
While protocols were put in place to authorise pharmacists to use alternative products where necessary, sometimes these measures were not sufficient. This led to the NHS providing guidance on crushing tablets and opening capsules to support children taking medication when liquid versions weren’t available.
While it’s difficult to correlate current drug shortages with Brexit, anecdotally, the changes in trade agreements between the UK and EU have led to additional bureaucracy, costs, supplier changes and delays.
In the UK, for many drugs we rely on only one manufacturer – which can be a risky strategy. Alteplase, for example, is the only drug licensed in the UK to treat acute ischaemic stroke – and this is produced by just one manufacturer. But supplies are running extremely low, which could have a serious affect on patients.
There are concerns that government agreements regarding pricing and supplier taxation (via the Voluntary Scheme for Pricing, Access and Growth) may discourage suppliers trading with the UK. This could lead to fewer suppliers and products in the UK system.
Globally, it’s challenging to set affordable prices in multiple markets and also provide manufacturers with acceptable returns on investment.
Some supply issues in the UK are also due to global spikes in demand – either due to increased prescribing of certain drugs or because of spikes in seasonal infections.
2024 outlook
Action is being taken to manage drug disruptions in the UK and Europe. The European Commmission has put a number of initiatives in place to reduce shortages in the EU – such as requiring suppliers to report shortages earlier, transparency and sharing of stock between countries and joint procurement strategies. It’s not clear if this will benefit the UK, but strong supply chains across Europe should be positive for global drug supply.
Some of the supply disruptions that affected UK drugs in 2023 will be resolved in 2024. For example, Besins, a pharmaceutical conmpany which manufactures HRT products, has increased its manufacturing capacity after opening a new factory in Spain.
The UK government is also working with manufacturers to ensure patients have continuous access to ADHD medicines. It’s expected ADHD drugs should be more readily available from April 2024.
Another measure that can help reduce drug shortages is issuing advisory notices about who should, or shouldn’t, be prescribed certain drugs. For example, a national directive was put in place advising that patients shouldn’t be prescribed Ozempic for weight loss. The approval of Wegovy for weight loss (which contains the same active ingredient as Ozempic) will also help to improve Ozempic stock levels – ensuring patients with type 2 diabetes can access this product.
Creating strategic stockpiles of important drugs will also help mitigate possible shortages and reduce supply disruption. This approach has already been adopted by the European Union. This approach is especially useful for drugs that may see seasonal spikes in demand – such as liquid antibiotics used for strep A.
All of us can also help reduce drug shortages and their affects on our care. Order prescriptions sensibly (so don’t order more at one time than you need), take medication as prescribed and don’t buy from unregulated sources if your regular prescription is unavailable. Hopefully, with the measures the government and suppliers have already taken, this will mean fewer shortages in 2024.