Medicine Shortages: Gaps Between Countries and Global Perspectives

Abstract

Introduction: Over the last decade, global health policies and different research areas have focused on the relevance and impact of medicine shortages. Published studies suggest there have been difficulties with access to medicines since the beginning of the 20th century, and there have been advances in our understanding and management of the problem since then. However, in view of global and regional health care concerns with shortages, we believe this phenomenon needs to be characterized and described more fully regarding the types of medicines affected, possible causes, and potential strategies to address these. The aim of this scoping review was to identify, compare if possible, and characterize the recent literature regarding the situation of medicines shortages between countries, and provide different perspectives, including a global context and national approaches. Methodology: A scoping study presented as a narrative review of the situation and findings principally based on published articles. Results: Based on the reported cases in the literature, a typology of medicines shortage and supply interruption episodes and their causes were proposed; national approaches to notify and manage the medicines shortages cases were described and classified by update frequency; principal differences between market and supply chain management perspectives of the situation were identified and global and countries’ perspectives were described. Conclusion: Policy makers require solutions that prevent those cases in which the population’s health is affected by episodes of medicine shortages and/or interruption in the supply chain. There is also a need to generate a glossary related to logistics management and the availability of medicines which will be useful to understand and overcome shortages. In addition, recognize that potential solutions are not only related with actions linked to research, development and innovation, but much wider. Overall, we believe this article can act as a basis for future discussions in this important area.

Medicine shortages and challenges with the procurement process among public sector hospitals in South Africa; findings and implications

“…Over the years, the shortage of medicines has been a challenge to the effective delivery of quality healthcare services worldwide including South Africa [1][2][3][4][5][6][7][8][9][10], with shortages of even essential medicines becoming a global problem irrespective of the economic status of countries [11][12][13]. More than half of the world's population do not have access to essential services [14], exacerbated by medicine shortages.…”

“…More than half of the world's population do not have access to essential services [14], exacerbated by medicine shortages. The origins of medicine shortages are complicated, can differ among regions and countries, and consequently potentially require different strategies to address them [5,6,15]. In the United States (US), the total number of new and ongoing shortages exceeded 450 in 2012 [12].…”

“…In Europe, a recent survey among hospital pharmacists showed there had been a significant increase in medicine shortages across Europe with 91.8% hospital pharmacists in 2018 experiencing shortages compared to 86.2% in 2014, with 35% experiencing them on a daily basis and 38% on a weekly basis [17], which is a concern. There are also considerable shortages in other continents and countries including other low and middle income countries (LMICs) across South America and wider [5,6,8,9].…”

“…Some of the contributing factors to the shortage of medicines include manufacturing and quality problems, production delays, lack of manufacturing capacity, shortage of raw materials, political instability, and profitability issues [5,6,8,9,18]. Other factors include long lead times, delays in awarding tenders, absence of national contracts on the regional code lists of medicines, the failure of suppliers to meet demand, and the failure to pay suppliers [2,19,20].…”

“…Regulatory issues contribute to the shortage of medicines especially if companies are unable to meet Good Manufacturing Practice and have their facilities closed down following an inspection of their facilities [23]. Early mandatory notification by manufacturers of any discontinuation or disruption in the manufacturing of a drug that could lead to a shortage is necessary in the management of medicine shortages are welcomed, with such systems in place in a number of European and other countries [5,6,24]. The Food and Drug Administration in the US adopted this particular strategy, which has resulted in quicker and more effective responses to medicine shortages [24].…”