Minneapolis, MN—In light of the United States’ dependence on drugs and drug components made in other countries, especially India and China, pharmacists should prepare themselves for shortages of critically needed medications, according to a new information.

The University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP) is working to provide a detailed map of the supply chain for essential drugs used in the U.S. as part of its Resilient Drug Supply Project. In the short term, however, the group has shared its concerns, providing a list of 156 drugs used in acute care that, if unavailable for a few hours or days, can lead to increased patient death rates.

“With the COVID-19 pandemic expected to last many more months and with more patients in need of life-saving drugs, we call upon the pharmaceutical companies and their partners to publicly come forward with current inventory levels and information on the status and relative resiliency of their critical drug supply chains,” said Michael T. Osterholm, PhD, MPH, coprincipal investigator of the project and director of CIDRAP.

Of most concern are medications such as epinephrine, various antibiotics, and albuterol, added Stephen Schondelmeyer, PharmD, PhD, coprincipal investigator with the project and a professor in the University of Minnesota’s College of Pharmacy.

Making the situation even more dire, Dr. Schondelmeyer noted, is that about 60 of those drugs were already in short supply before the emergence of COVID-19.

“We're getting reports from pharmacies that there’s a shortage of albuterol inhalers for people with asthma,” he said. “There seems to be a run on getting asthma inhalers. There may also be some production issues.”

An issue is that more than 80% of the drugs marketed in the U.S., including 19 of the 20 top-selling brand name ones, are made overseas, Dr. Osterholm pointed out, adding, “I think most people would be surprised that 18 of the 21 critical antibiotics we use here are all generics, and they’ll be critical in treating secondary infections in people hospitalized with COVID, and that the U.S. drug supply is so dependent on foreign sources.”

The problem is two-pronged, according to the group, with COVID-19 increasing demand for some drugs and with drug production slowed down or halted in countries grappling with the virus.

CIDRAP points out that drugs distributed in the U.S. are often made in China—estimated to be about two-thirds of generics—and then shipped to India for manufacturing into finished products. For example, at least two-thirds of the active ingredients for generic drugs used in the U.S. come from China.

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