Brexit and coronavirus: a perfect storm for UK drug shortages?

Night sweats, insomnia, mood swings. These are just some of the symptoms experienced by women across the UK who have been unable to access hormone replacement therapy (HRT). Drug shortages in the UK started hitting the headlines in late 2019 as the UK’s impending exit from the EU loomed. Now, combined with a global pandemic, the UK has experienced unprecedented drug supply issues and, as a result, many patients are suffering.‍

Hormone replacement products have been particularly affected, resulting in widespread supply problems. This has become a frustrating issue as HRT products are a key therapeutic avenue for the one in four peri- or post-menopausal women that experience severe debilitating menopausal symptoms. One British woman explained how she searched for her prescribed HRT drug at several pharmacies over a period of 6 months only to be told that it was not possible to purchase it anywhere. She then tried an alternative product only for her symptoms to return almost immediately.

Unfortunately, the problem is not just limited to HRT. Shortages are also emerging in the supply of contraceptives, blood thinners, cancer medication, cardiac drugs, and asthma medication, among others. Particularly concerning is the shortage of certain antiepileptic medications. Unlike most drugs, which can be easily substituted for similar alternatives, even a slight change in epilepsy medication can lead to devastating and life-changing consequences.

The cause of drug shortages is unclear and may be multifactorial. One cause could be logistical issues at the border arising from the imminent possibility of a no-deal Brexit. Seventy-five percent of Britain’s medicines arrive via the European border and could be influenced by increased border checks. As a result, the government issued a directive to pharmacies to stockpile 6 weeks’ worth of medicines to ensure an unimpeded supply to the British population.

Then, along came COVID-19, exacerbating an already precarious situation. The NHS imports 80–90% of its drug supply from abroad, and it is this dependence on imported medication that has exposed the fragility of the drug supply chain during the COVID-19 pandemic. Many of the active pharmaceutical ingredients needed for manufacturing medicines are sourced from countries such as China. COVID-19 stopped factory production in China and, as a result, the supply of active pharmaceutical ingredients to countries that manufacture medication was halted. As a result, India, the world’s largest producer of generic drugs, had to place limits on the export of key medicines such as paracetamol, antibiotics and statins, with no indication of when these restrictions will be lifted.

Initially pharmacies were able to use their 6-week stockpiles left over from Brexit planning; however, these stockpiles have been eroded. In addition, the supply of paracetamol and ibuprofen has been put at risk due to panic stockpiling of medications by the general public.

At the height of the pandemic, manufacturers focused on the production of medications essential to the treatment of COVID-19, signalling a change in routine production. This has caused medicine shortages in its own right and is now limiting the ability of the government to rebuild its stockpile in the event of a no-deal Brexit.

The COVID-19 pandemic is likely to have an impact on the drug supply chain in the UK for years to come. Therefore, the focus should now fall on creating solutions that ensure the supply of essential medication is not affected by global events.

Sources

https://www.gmjournal.co.uk/why-is-there-a-shortage-of-hormone-replacement-therapy

https://www.pharmaceutical-journal.com/news-and-analysis/features/the-true-impact-of-the-uks-hormone-replacement-therapy-shortages/20207775.article?firstPass=false

https://www.thelancet.com/action/showPdf?pii=S0140-6736%2819%2932264-0

https://www.bmj.com/content/369/bmj.m2283