Medicine shortages have become a pressing concern, affecting the public health sector worldwide and occurring daily in all healthcare settings, so that everyone involved in patient care is impacted.

Back in 2010, Community Pharmacy England (CPE) – then the Pharmaceutical Services Negotiating Committee (PSNC) – predicted that pharmacists will be carrying out a routine pursuit of low and missing stock. This prediction has proven true, with a recent survey by CPE ranking medicine supply instability as the most severe pressure faced by community pharmacies.

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The importance of information while dealing with medicine shortages is widely recognised across all healthcare settings. However, despite publicly available databases in most countries, a recent study found that only half of pharmacists saw their national system as useful.

The European Commission also highlighted the challenges pharmacists have to face to obtain accurate data on medicine shortages, lamenting the inconsistent and limited reporting that hampers us from developing a proper understanding of the issue.

 

Let’s react, not pre-empt

 

Despite the efforts of government bodies and regulators to mandate reporting from manufacturers and wholesalers, most shortages are only being detected by pharmacies. This means that pharmacies often only become aware of medicine shortages when an order fails to arrive, or when a sudden increase in price occurs.

In my experience of the pharmaceutical industry, national reporting tends to lag and is behind by at least four weeks, while sufficient information is gathered and investigated. I think that this delay may result in a lack of adequate mitigation plans such as serious shortage protocols (SSPs) or price concessions.

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Local shortages, which can have a significant impact on pharmacies, are not being reported in national databases. Our research, which has not been published publicly, indicates that the number of supply issues faced by pharmacies is more than four times the number recorded in the national database.

This disconnection between the experiences of pharmacies and national reporting creates a void that could exacerbate the existing issues; for example, the amoxicillin shortage last winter. Pharmacists in the UK began reporting difficulties in procuring the antibiotic as early as November 2023, with widespread issues reaching the national press and social media in early December. I want to note that some pharmacies had reported access to sufficient amoxicillin supply, but to a lesser extent.

The Department of Health and Social Care (DH), suppliers and government officials, including Rishi Sunak, insisted that there were ample supplies available. Less than eight days later, a medicine shortage notification was issued, followed by an export ban and the implementation of eight SSPs on December 15 and 16.

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Could this shortage have been anticipated and addressed before it reached the point of crisis? What role did prescribing volumes of amoxicillin, beyond normal winter levels due to rising levels of strep A infections, play in this crisis? Were there any manufacturing issues, as suppliers claimed there were enough supplies?

 

Shortages are both global and local

 

Interestingly, the UK was not the first country to face amoxicillin shortages last year. Issues were first reported in Australia, followed by the US and then Canada and France, before spreading across most of the European Union (EU).

However, it's important to approach such instances with caution because a shortage in one country doesn't necessarily indicate a global problem. In fact, the EU has emphasised that most shortages are localised, suggesting issues with unequal distribution and access rather than global supply problems.

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Apart from having national databases, there is presently no early warning system in place to alert key personnel at any level about emerging medicine shortages. The industry still heavily relies on reactive manual efforts to search for alternative sources or medications, without knowing the extent of the shortage, its likely duration, or the underlying cause.

To improve the supply of medicines, we must prioritise reporting and tracking each medicine shortage and any challenges, including pricing issues. I think that it's crucial to understand the full extent of the problem in order to develop effective solutions. Medicine shortages can be reported to CPE, and pricing issues can be reported here. Other pharmacy bodies and iEthico also accept shortage reports.

But reporting alone isn't enough. We need to use data to anticipate issues before they arise. By combining information from sources like social media, international trends, and prescribing data, we can identify shortage signals. This proactive approach allows for better planning and mitigation, rather than scrambling and reacting.

However, sharing information quickly presents a challenge. We need to prevent panic buying, hoarding, and commercial opportunism without worsening the problem. In a market with high demand, this is a significant hurdle. Just think back to the toilet paper shortages during the COVID-19 pandemic. So, how can we provide shortage warnings without causing actual shortages?

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By increasing collaboration between everyone in the medicines supply chain, and particularly arming prescribers and pharmacists with a complete picture of medicine availability, we could improve the effectiveness of this process. If we create a single view of all the information available, it will be possible to take more pro-active decisions about mitigating shortages.

Of course, access to information alone will not solve the medicine shortages problem, as we need to do more to empower pharmacists to find and share stock; as well as offer wholesalers and pharmaceutical companies more predictability in contracts so they know how much they can invest in UK stocks.

However, none of this can happen without a clear single view of the data within the supply chain. Better access to information will lead to better decision-making, which will ultimately mean better patient care.

Debra Ainge is the chief executive and co-founder of iEthico