Critical Drug Shortages Plague US Amid Unabated Reliance on China

Critical Drug Shortages Plague US Amid Unabated Reliance on China
(Illustration by The Epoch Times, Shutterstock)
December 28, 2023
January 05, 2024

The ongoing scarcity of critical medications has trapped Americans between a rock and a hard place.

Active national drug shortages hit a 10-year high this year, leaving many health care providers, pharmacies, and hospitals without enough life-saving and supportive medications, according to data collected by the University of Utah Drug Information Service.
A survey by the same university in July found that 99 percent of the 1,123 pharmacists who responded—many of whom work in hospitals—reported shortages. One-third of the pharmacists listed the shortages as “critically impactful,” which is defined as being forced to ration medication or delay or even cancel medical treatments.
The U.S. Food and Drug Administration lists 124 medications in short supply as of Dec. 21; the list topped out at 309 earlier this year.
The shortage applies to multiple categories, including antibiotics—both amoxicillin and azithromycin are on the list—and staple analgesics such as ketamine, as well as nitroglycerin injections, a vital tool in helping to control congestive heart failure in heart attack patients.

Securing medication is also a challenge for those managing chronic illnesses.

Jennifer, a Waterford, Michigan, resident who asked that her last name not be disclosed, told The Epoch Times that she was only recently able to start taking her Type 2 diabetes medication again after being stranded without it for the second time since July 2022.

She started taking Ozempic again on Dec. 10, after being unable to fill her prescription for weeks.

Ozempic is one of the many drugs affected by current shortages; that’s reportedly due, in part, to Ozempic’s off-label use as a weight-loss supplement. The manufacturer, Novo Nordisk, lists the official reason for the shortage as “increased demand.”

“The pharmacist told me it’s on back order and, ‘You need to call around to see if other stores or pharmacies have it in stock.’ And I’m like, no, that’s your job,” Jennifer said.

She was noticeably frustrated—there are physical consequences of having gaps in her medication. In addition to managing her A1C levels, the drug comes with unpleasant side effects for some patients, which take time to wear off.

A woman walks past a CVS Pharmacy in Washington on Nov. 2, 2022. (Brendan Smialowski/AFP via Getty Images)

One of these is extreme lightheadedness, which Jennifer has encountered each time she’s restarted taking Ozempic after enduring a usage gap. She said she gets dizzy to the point of feeling like she’s about to “pass out” after resuming the medication.

“I haven’t taken it for weeks, and now I’m having a reaction [side effects] since it’s all been flushed out of my system,” she said.

Unpleasant side effects aside, Jennifer says she feels like she doesn’t have a choice other than to ride out the medication gaps when they happen, because the drug has helped manage her diabetes so well.

But medication scarcity isn’t a new problem. U.S. drug shortages have plagued Americans for nearly 20 years.
A 2011 study observed that increasingly frequent drug shortages had been a problem during the past decade. They were attributed to the same hurdles the industry faces today: Challenges in acquiring raw materials, manufacturing and regulatory problems, and supply chain disturbances.
There’s also the heavy reliance on other countries to manufacture pharmaceuticals, which some U.S. lawmakers say leaves the country too dependent on foreign drug manufacturing.
“Currently, about 90 percent of drugs dispensed at U.S. pharmacies are generic drugs that overwhelmingly come from communist China and India,” Sen. Rick Scott (R-Fla.) said in a September statement upon introducing his American Drugs Act, which would create “a strong incentive for companies to invest in domestic pharmaceutical production.”
A worker inspects bottles of drugs on a product line at a pharmaceutical factory in Weinan, China, on April 6, 2006. (China Photos/Getty Images)

“Americans can’t trust communist China and can’t allow any reliance on Xi’s evil regime for life-saving medicine,” Mr. Scott said.

Currently, the United States leans heavily on other countries to manufacture key starting materials (KSM) and active pharmaceutical ingredients (API), which are the critical building blocks of pharmaceuticals.

As of 2021, China became the world’s leading supplier of both KSMs and APIs, according to a report issued by the European Parliament.
In March, a U.S. congressional strategic preparedness committee noted that up to 95 percent of generic sterile injectable drugs used for critical acute care in the United States rely on KSMs from China and India.
Reliance on foreign production of U.S. pharmaceuticals is an issue that former President Donald Trump identified and attempted to address during his term. Alongside the America First Healthcare Plan, President Trump’s $354 million deal in 2020 with U.S.-based Phlow Corp. was an effort to increase domestic manufacturing of generic drugs and APIs.
More than three years later, in September, Phlow said it was manufacturing APIs for the “federal government, to be stored in the nation’s first reserve of APIs.”
“This will ensure the resiliency and availability of critical medicines in times of geopolitical crises, trade disputes, natural disasters, or future public health emergencies,” Eric Edwards, CEO and co-founder of Phlow, said in a statement.

He said the company is also making KSMs and “rebuilding a resilient domestic supply chain.”

A pharmacist prepares to fill a prescription at a community health center in Aurora, Colo., on March 27, 2012. (John Moore/Getty Images)
The Biden administration has also responded to the widespread outcry over drug shortages, prompting a November White House announcement that the Defense Production Act (DPA) will be used to encourage investment in the domestic manufacturing of  “essential medicines, medical countermeasures, and critical inputs that have been deemed by the president as essential to the national defense.”
The DPA grants a sitting president extensive authority to manage vital economic resources, including the power to expand domestic production.

Plans to achieve this include expanding the Department of Health and Human Services (HHS) under Title III of the DPA. Some of these changes include $35 million for investments in domestic production of KSMs for sterile injectable medications. Additionally, the HHS will designate a new supply chain resilience and shortage coordinator in an attempt to address medication and other supply chain shortages.

But those who work in the trenches of health care say these efforts are a drop in the bucket compared to what’s needed and that barriers to increased U.S. drug manufacturing won’t be easy to overcome at either a legislative or a logistical level.

Dr. Jared Ross, the president of Emergency Medical Services, Education & Consulting LLC, and a medical director at the Henry Ford College paramedic program, says foreign API production isn’t the root of the problem.

“The larger issue is with key starting materials, which are used to make the APIs,” he told The Epoch Times.

“We need to bring KSM manufacturing back to the United States.”

In his work, he sees the effects of drug shortages up close and personal.

“The hospital where I do most of my clinical work has experienced several shortages. We are conserving injectable penicillin to treat syphilis, which means we have to use oral medications for strep throat, which are less effective and harder to administer to young children,” he said.

Dr. Ross rattled off a list of adaptations he’s seen as part of the fallout of America’s drug shortages in hospitals. He noted that high concentrations of ketamine are in short supply, limiting the ability to give it as an “intramuscular injection, forcing us to start unnecessary and painful IVs or use alternative medications that aren’t as safe.”

Bottles of prescription drugs are filled as they move down an automated line at a pharmacy in Midvale, Utah, on Dept. 10, 2018. (George Frey/Getty Images)
Bottles of prescription drugs are filled as they move down an automated line at a pharmacy in Midvale, Utah, on Dept. 10, 2018. (George Frey/Getty Images)

He said that certain IV benzodiazepine medications such as lorazepam and midazolam are scarce, forcing health care professionals to use diazepam, also known as valium, to treat seizures.

It’s a scenario Dr. Ross describes as “less than ideal.”

He said bringing KSM manufacturing to the United States is logistically complicated and cost-prohibitive. He maintains that the current cost factor is “insurmountable” due to regulatory compliance, especially in the environmental sector.

“We need less government regulation and more free-market solutions,” he said, noting that throwing a few hundred million dollars at the problem by any administration isn’t a real solution and that America needs to “cut out the red tape.”

A view of the Capitol's Rotunda is reflected in an ambulance near Capitol Hill in Washington on March 24, 2020. (Brendan Smialowski/AFP via Getty Images)

Dr. Ross said the issue of drug shortages is often viewed through the lens of “essential medication production,” but he believes it’s a symptom of a larger decline in U.S. manufacturing, which he asserts hasn’t been able to stay as competitive amid “burdensome” regulations.

“We will have to accept increased labor costs. But there is a lot that we, our government, can do to decrease compliance costs,” he said.

Practicing clinician Chris McDermott, founder of Intercoastal Consulting & Life Care Planning, told The Epoch Times that drug manufacturers dragging their heels on domestic production doesn’t help the situation.

“In my professional journey, it’s become apparent that the reluctance of drug manufacturers to shift production domestically is not solely due to legislation. An often overlooked aspect is the complexity of retooling existing facilities,” Mr. McDermott said.

He noted that “significant investment and time” will be required to ramp up manufacturing within the United States and could disrupt current production models for some manufacturers.

“Patient stories are both a source of inspiration and a stark reminder of the tangible consequences of medication shortages,” Mr. McDermott said. He said he has encountered “numerous cases where patients have faced dire consequences due to the unavailability of essential medications.”

“These instances highlight the urgent need for comprehensive strategies to address and prevent drug shortages, placing patient well-being at the forefront,” he said.

Dr. Kelvin Fernandez, a tutor and medical residency advisor at Ace Med Boards, agrees with this assessment.

“Both legislative aspects and reluctant drug manufacturers play important roles in the lack of progress,” he told The Epoch Times.

“Navigating bureaucracies can be arduous, and companies might hesitate due to increased costs associated with domestic manufacturing.”