How Medicine’s Long, Thin Supply Chain Threatens Americans

On the website of the Food and Drug Administration, there’s a page where the agency lists drugs that are in short supply in the United States. Last week, there were 90 entries on the list: antibiotics, drugs for anesthesia, compounds to light up veins and organs for imaging, immunosuppressives to prevent organ rejection, tube-feeding solutions, sedatives. For every type of medical problem, an important drug is off the market or in short supply—and this is routine.

In the fall, after Hurricane Maria tore through Puerto Rico, something new joined the list, not a drug but a category of medical equipment: bags of sterile salt water. When the territory’s electrical grid went down, it took out several plants that make bagged saline for US manufacturer Baxter International. Few noticed at first, until this winter’s flu season got bad. One of the first things you do when someone arrives at a hospital weak and feverish is plug them into a quart bag of saline to rehydrate them. Another might be giving them drugs through a smaller bag hooked to an IV drip. In many hospitals, both were suddenly rationed.

Maryn McKenna (@marynmck) is an Ideas contributor for WIRED. She writes about public and global health and food policy, and she is a senior fellow at the Schuster Institute for Investigative Journalism at Brandeis University. She is the author of Beating Back the Devil, Superbug, and Big Chicken: The Incredible Story of How Antibiotics Created Modern Agriculture and Changed the Way the World Eats. She previously wrote WIRED’s Superbug blog.

Missing IV bags and missing pharmaceuticals seem like unrelated problems, a temporary disruption layered on top of a longstanding problem. But in fact, they are unavailable for the same reason. The United States has allowed the manufacturing of most of its drugs and medical devices to drift offshore, at the end of long, thin supply chains.

If a single hurricane can break one of those chains, undermining the delivery of medical supplies that Americans need every day, imagine the impact of a border-crossing epidemic or a regional military conflict or a natural disaster like the volcanic eruption that shut down most of Europe’s airspace in 2010.

This ought to be a matter of national security. So far, it’s not.

Most people don’t have contact with the ongoing drug and IV shortages, so they can come as a shock. “My wife’s nurse had to stand for 30 mins and administer a drug slowly through a syringe because there are almost no IV bags in the continental US anymore,” Ben Boyer, a former TV executive who lives in San Diego and whose wife is undergoing chemotherapy for brain cancer, tweeted on December 28.

To physicians, though, it’s hellishly normal. “I am on staff at several different hospitals in western Pennsylvania, and there are weekly emails: These are the fluids on shortage, these are the ones in stock,” says Amesh Adalja, an infectious-disease physician and a senior scholar at Johns Hopkins University’s Center

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