On February 17, 2021, The Globe and Mail hosted an online summit to explore the impact of drug shortages in Canada before and during the pandemic. For plan sponsors, this issue is clearly important because access to appropriate medications can keep employees healthy and productive at work. So, what did the panelists have to say?
Dr. Jacalyn Duffin, professor emerita and Hannah chair of the history of medicine at Queen’s University, told the Drug Shortages Summit that shortages affect different drugs at different times, but that they can have an impact on treatments for “just about every class of disease you can imagine.” She has identified 17 different reasons why drug shortages happen.
One of the most important is that lower prices for generics can cause manufacturers to stop producing certain medications, leaving no alternative if one manufacturer experiences challenges. During the pandemic, other reasons that have risen to prominence include increasing demand – for example, after U.S. President Donald Trump promoted hydroxychloroquine to treat COVID-19 – and difficulties in obtaining raw materials across borders.
The hydroxychloroquine shortage directly affected Jillian Kuchard, a volunteer at the Arthritis Society, who counts on the drug to help keep her rheumatoid arthritis in check.
“Without that drug, my normal daily routine is completely impacted, my life is impacted, the ability to even walk around and be able to exercise and things like that are all really dependent on the drugs that I take,” she said. “I didn’t want to get to the point where I was risking a flare-up. I have to go to work. I have to be able to function. And I know how miserable I can be when I have flared up in the past. It’s really debilitating.”
Kuchard added that her pharmacist worked hard to make sure she received enough hydroxychloroquine despite the shortage but, underlining the impact on patients, she said it was a terrifying experience.
Christina Tulk, a pharmacist/owner who is chair of the Canadian Pharmacists Association, put that hard work by pharmacists in perspective. She said that managing drug shortages can take up to 20% of her day, and that was true pre-pandemic as well as during the pandemic. Tulk strongly advocates expanding pharmacists’ scope of practice to allow them to make therapeutic substitutions – something that is allowed in some, but not all, provinces. However, she also pointed out that drug shortages can create a domino effect, where pharmacists may be able to replace the absent Drug A with Drug B, but that can cause a shortage in Drug B.
“This is a global problem [with] lots of supply chain issues,” acknowledged Dr. Rakesh Patel, assistant professor of medicine and program director for adult critical care medicine at the University of Ottawa. But he emphasized that doctors, too, can help mitigate the consequences of drug shortages. “The one thing we can actually control in the hospital, and our approach over the last 10 to 12 years, really has been to manage the demand. So, at the prescriber level, trying to prioritize who actually needs the drug that is in shortage,” he explained.
Meanwhile, to better manage supply chains, Angelique Berg, senior vice-president, stakeholder engagement, for the Canadian Association for Pharmacy Distribution Management, says that for Dr. Duffin’s 17 reasons for drug shortages, there are six times as many solutions.
“It’s really important to acknowledge the realities of our market today,” she added. “The majority of our drugs are manufactured off-shore, and that makes them less controllable and it makes the market less responsible. It doesn’t necessarily mean the sky is falling, but we do have to be very planful and coordinated and astute at actually anticipating our need and the market shifts that are going to come forward so that we can make the very best use of our place on the global stage.”
The challenges of off-shore manufacturing don’t necessarily mean Canada should (or can) bring drug manufacturing home, said James Scongack, executive vice-president, corporate affairs and operational services, at Bruce Power, which produces medical isotopes domestically for the Canadian and international market. “We are an amazing country … but we are a very small country relative to the size of our economy, the size of our population compared to the biggest players,” he pointed out. “What that really requires is for us to really pick those sweet spots. Where can we punch above our weight?”
What are some of those sweet spots? “We’re very good at the early stages of research, and also we’ve got some leading artificial intelligence firms that are trying to identify molecules that eventually have a higher chance of making it through to the patient,” suggested Richard Gold, James McGill professor in the faculty of law at McGill University. To leverage our strengths, he’d like to see the federal government to take a more active role in identifying and investing in areas like this, so academic, industrial and patient organizations can collaborate more effectively to improve drug supply.
Dr. Durhane Wong-Rieger, president and CEO of the Canadian Organization for Rare Disorders, also emphasized the importance of partnerships – with the provinces, the federal government, private drug plans, hospitals, patients and pharmaceutical companies.
“It’s got to be a collaborative effort where everybody needs to make sure that we are all focused on the same thing, and that is how to get the right drug to the right patient in a way that’s going to be most system-effective, not just what’s going to be the cheapest price,” she emphasized.