COVID-19 has brought many challenges — but even before the pandemic, Canada was experiencing shortages for medications such as EpiPens. These complicated supply issues create problems across the entire healthcare system, impacting medical professionals and patients alike.
So what can be done to fix it? That was the focus of The Globe and Mail’s recent online summit. For those who weren’t able to attend, or simply want a recap of what was discussed, we’ve summarized the key takeaways below. Read on to see what the panelists had to say.
Patients are the first to feel the effects.
Dr. Jacalyn Duffin, professor emerita and Hannah chair of the history of medicine at Queen’s University, explained that shortages affect different drugs at different times for different reasons.
For some drugs, such as hydroxychloroquine, increased demand is responsible for the shortage. It can also sometimes be difficult to obtain raw materials across borders. Whatever the situation, these shortages can have an impact on treatments for “just about every class of disease you can imagine,” said Dr. Duffin.
The hydroxychloroquine shortage, for instance, 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. 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.
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.
Physicians and pharmacists can take the first step.
Christina Tulk, pharmacist and chair of the Canadian Pharmacists Association, put that hard work into perspective. She said that managing drug shortages can take up to 20% of her day, and that was true even before the pandemic.
Tulk strongly advocates for 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.
We can all work together to find a solution.
Meanwhile, to better manage supply chains, Angelique Berg, senior vice-president, stakeholder engagement, for the Canadian Association for Pharmacy Distribution Management, says that for every reason a drug shortage occurs, 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.”
What are some of Canada’s specialties? “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 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.
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