Australia facing medicine shortage, TGA says over 320 drugs affected

Australia is facing growing shortages of medicines due to continued supply chain disruptions, sparking renewed calls to reduce the country’s near-total reliance on India and China for lifesaving drugs.Doctors and pharmacists have sounded the alarm that patients are at risk from the worsening crisis, with 321 medicines currently listed by the Therapeutic Goods Administration as facing shortages – nearly 50 of which are rated critical – with another 85 expected to join the list.Drugs for diabetes, depression, anxiety, stroke, nausea, hormone replacement and cancer treatment are among those listed as either currently or soon to be in short supply, or completely unavailable.Dr Cathryn Hester, Queensland deputy chair of the Royal Australian College of General Practitioners (RACGP), said urgent action was needed.“The shortage of certain medicines is becoming an increasing problem in Australia, and it’s really been made worse by the Covid-19 pandemic which has affected international supply chains,” Dr Hester said.“GPs are seeing more patients who are telling them that they can’t get the medicines they’ve been prescribed from their local pharmacy. GPs often have a good relationship with the pharmacies in their local area, and will work with them to help get medicines their patient needs if they are struggling to find it. We can also sometimes find a substitute for a certain medicine, but medicines are not easily substituted between each other.”Dr Hester said Australia needed to “fix this problem with a long-term solution because when people go without medicines they need it can adversely affect their health and wellbeing”.Pharmaceutical Society of Australia (PSA) national president Dr Fei Sim said medicine shortages had been an issue for a “long time”, but the pandemic had put further pressure on supply chains.“Shortages are affecting a range of medications, from off-the-shelf cold and flu medications, to prescribed medicines like the diabetes drug Ozempic,” she said.“The demand for common medicines like paracetamol are increasing, as Australians are dealing with a variety of illnesses going around.”Under a new medicines supply guarantee between the federal government and drug companies, manufacturers will be subject to minimum stockholding requirements of four to six months for certain key brands listed on the Pharmaceutical Benefits Scheme.But the new rules don’t kick in until July 1, 2023.Stream the latest health news with Flash. 25+ news channels in 1 place. New to Flash? Try 1 month free. Offer ends 31 October, 2022 >Dr Sim welcomed the guarantee, which will come with price rises for up to 900 different medicines, but said “more needs to be done to ensure a consistent supply of PBS medications”.“Many people rely on these essential medicines for their health and wellbeing,” she said.“PSA and the entire health sector are working with the Department of Health and the government to ensure consistent and continued supply of vital medicines. It is always best to work together with your pharmacists and doctor, if one medicine happens to be unavailable, your health care team will work with you to ensure you have the best access to available care. Pharmacists will work with you if there’s a shortage of non-prescription medications and suggest alternatives.”Pharmacy Guild acting president Nick Panayiaris told The Guardian the shortages exposed “a whole sovereign risk issue here”.“We used to be great manufacturers of medication in the country, and unfortunately more and more of that has been lost, especially the generic medicine industry where a lot of that now is based in India and China and so forth,” he said.“So the government needs to seriously look at this, because they’re not just any commodity, they are essential medicines, which basically keep people alive.”He added pharmacies were getting “smashed” for off-the-shelf products such as liquid paracetamol as the winter cold and flu season coincides with another surge in Covid cases.“We’ve got increased demand for paracetamol use, and unfortunately right now that’s a huge problem for us at a pharmacy level in terms of having a critical medicine that we really need to have when people are suffering from the effects of Covid,” he said.“There’s no certainty at the moment of when we’ll get a reasonable in-stock position with these things at the moment – it’s just a bit of Russian roulette, to be honest with you.”Amid the disruptions caused by the Covid pandemic, former Treasurer Josh Frydenberg last year asked the Productivity Commission to assess risks to Australia’s supply chains.The final report, released last August, concluded while Australia’s supply chains had been disrupted by Covid and trade tensions, “most essential supply chains have proven resilient”.“While people have been understandably feeling apprehensive about supply chains, only a few traded products are vulnerable,” the Productivity Commission’s Jonathan Coppel said in a statement.“Businesses can usually manage these risks through stockpiling, contracts and diversification.”Australia imported 5950 different products in 2016-17 worth $272 billion, or about 16 per cent of gross national income.Pharmaceutical products were the fifth largest import category at $10.6 billion, after vehicles, machinery, electrical equipment and mineral fuels.“At the beginning of the Covid-19 pandemic, many raised concerns about Australia’s reliance on imported active pharmaceutical ingredients (APIs) and other pharmaceutical inputs,” the report said.“Australia imports most of its pharmaceutical goods from Europe and the United States, who rely increasingly on APIs manufactured in India and China. As of 2017, China produced 40 per cent of APIs globally and India supplied 20 per cent of global exports of generic medicines.”Disruptions to Indian and Chinese production during the pandemic led to concerns of shortages in Australia, leading to panic buying and stockpiling and subsequent purchase limits imposed by the government.“Despite concerns, the Australian pharmaceutical supply chain was ‘strong and stood up well to the challenges posed by the Covid-19 pandemic’,” the report said, citing a submission from Medicines Australia.“Shortages of other medicines caused by the Covid-19 pandemic have also been reported, such as some hormone replacement therapies and antidepressants. However, this does not appear to be out of the ordinary. Medicines Australia noted that ‘medicines shortage events, while perhaps more focused on products prone to hospital and public stockpiling due to [Covid-19], did not increase in Australia in 2020’.”The Productivity Commission stressed that medicine shortages were common even before the pandemic, affecting patients, doctors and pharmacists.“The combination of intense price competition (especially in the generics market) and a lack of transparency in supply chains hampers the ability of firms to assess accurately (and therefore reward) good quality management and supply chain resilience, which leads to shortages,” it said.However, the Institute for Integrated Economic Research – Australia (IIER-A) has previously warned that Australia is dangerously dependent on imported medicine.In early 2020, an IIER-A published a report highlighting that Australia imports more than 90 per cent of its medicines and sits at the end of a very long global supply chain, leaving it vulnerable to disruption.“Australia is particularly vulnerable to medicine shortages arising from factors outside our control,” retired Air Vice-Marshal John Blackburn and Anne Borzycki from the IIER-A wrote in an opinion piece at the time.“These factors can include manufacturing problems, political instability, pandemics, another global economic crisis, and natural disasters. Of particular concern is the just-in-time nature of Australia’s supply chains. While just-in-time makes sound business sense, it makes Australians vulnerable to disruptions in the supply chain, be they inadvertent or deliberate.”In an October 2021 report by IIER-A slamming Australia as “a complacent nation”, the group warned that the pursuit of cost efficiencies had “resulted in significant erosion of our healthcare systems and their resilience as our nation gradually lost manufacturing capacity to the point where we now import more than 90 per cent of our medicines and virtually all our personal protective equipment”.“This occurred without ensuring sufficient buffers in a crisis through stockholding mandates,” the report said. “Lower prices in normal times can come at a very high cost in a crisis.”Health Minister Mark Butler has been contacted for comment.frank.chung@news.com.auOriginally published as ‘Increasing problem’: Australia facing shortages of more than 320 medicines