NHS leaders and medical charities are calling for ministers to bring more drug manufacturing to the UK to reduce the risk of future shortages after the problems seen during the coronavirus crisis.
In addition to the well documented shortages of personal protective equipment, dealing with Covid-19 has placed huge strain on supplies of intensive care medicine, over-the-counter drugs and oxygen. The NHS has been forced to put new rationing measures in place to ensure hospitals do not run out.
Both the NHS Confederation and Kidney Care UK, the charity that raised the alarm with health officials when Britain faced a shortage of dialysis fluids for coronavirus patients suffering kidney injury, say the government needs to focus on increasing British manufacturing. Academics and pharmaceutical industry bodies also support the idea, which may need tax breaks or subsidies.
Layla McCay, director of International Relations at the NHS Confederation, which represents 500 NHS bodies and leads the Brexit Health Alliance of health groups during negotiations with the EU, said the UK needed to play “its full part” in the global supply of medicines.
“Future government policy should ensure that the UK is as attractive as possible for the next wave of manufacturing innovation,” she said. “We need to be investing in infrastructure to build the facilities to do this. And we need to be investing in talent, which means attracting the top scientific brains to the UK and the top manufacturing talent.”
NHS England told hospital trusts last month to limit dialysis because one in four Covid-19 patients in intensive care need kidney support.
This led to a critical lack of fluids, according to Fiona Loud, policy director at Kidney Care UK. The shortage has abated due to better management, and does not affect 30,000 patients on regular dialysis.
No dialysis fluids are made in the UK; they are shipped in by three international suppliers, Loud said. There had been previous shortages caused by earthquakes in Italy in 2012, where one supplier is based.
“We need to learn from this,” Loud said. “The supply chain isn’t as good – isn’t as robust – as it could be. If it cannot be guaranteed, there has to be a commitment to some UK initiative on this.”
Academics have also called for the government to potentially subsidise the mass production of pharmaceuticals in Britain. Andrew Hill, a research fellow at the University of Liverpool, said in the Guardian it was time to “re-evaluate the case for manufacturing more medicines in the UK”. Samuel Roscoe, a senior lecturer in Operations Management at the University of Sussex, gave evidence to the Commons trade select committee last month calling for a “major structural change in supply chains”.
Drug shortages are not new, and are a global problem. The Medicines and Healthcare products Regulatory Agency (MHRA) now has 196 medicines which cannot be hoarded or exported from the UK – so-called parallel exports. There were only 29 products on the list at the beginning of 2020.
Many of the shortages relate to hormone replacement therapy. Women going through the menopause have experienced shortages since 2018. The prospect of a no-deal Brexit also alarmed diabetes sufferers because all insulin is imported. Asthma inhalers – some of which are made in Britain – are also in short supply in some parts of the UK.
Global supply chains are long and complex. About 70% of all base ingredients for drugs – active pharmaceutical ingredients (APIs) – are manufactured in China. Those ingredients are blended and packaged into medicines – India is the biggest supplier to the UK – but some are made in Europe and about 20% to 25% are made in the UK, according to the British Generic Manufacturers’ Association (BGMA).
In evidence to the Commons trade select committee, published last week, the BGMA said there had not been any direct impact on supply because pharmaceutical companies hold large stockpiles of APIs. Disruption caused by the Chinese lockdown had not yet affect those supplies, it said.
“A multi-layered approach is needed, which may well need to include, in addition to an enhanced UK manufacturing base, holding appropriate buffer stocks in the UK to deal with unanticipated future shocks to supply or peaks in demand; investment in the ability to increase or refocus production of specific medicines in times of crisis; and regulatory and procurement changes to incentivise manufacturers to build in resilience to their supply chains rather than simply to charge the lowest price.”
Richard Torbett, chief executive of the Association of the British Pharmaceutical Industry, which represents pharmaceutical firms that make branded prescription medicines, said the supply chain had been remarkably resilient.
“Given the scale of the global crisis, really, there is only one group of medicines where there is a supply disruption notice from the MHRA,” he said.
“It always makes sense to ask the question: how can we be more even more resilient in the future? And I do agree that part of the story should be around what can we manufacture in this country. It makes sense in the UK to think about incentives and think about what can and should be manufactured here. But I think it should be one part of a holistic strategy that also includes making sure that the global system still operates, and is as diverse as possible.”
İnformation source: here