The outbreak of the novel coronavirus disease, COVID-19, has disrupted the Chinese economy as the government shuttered cities and imposed travel restrictions, the International Monetary Fund has said.
And as China is also a major global pharmaceutical manufacturer, experts are starting to ask what this disruption could mean for the world’s drug supply.
“Pharmaceuticals across the board really are at risk,” said Thomas Bollyky, director of the Global Health Program at the Council on Foreign Relations in Washington, D.C.
“China produces 80 per cent of the world’s supply of active pharmaceutical ingredient. Those are the parts of the pills that actually do something.”
Antibiotics are of particular concern, he said, “Not only because so much of those supplies come out of China, but because they play a systemic role in the health care system.”
Very few of Canada’s drugs are actually made domestically, said Dr. Jacalyn Duffin, a hematologist and medical historian, and professor emerita at Queen’s University.
Duffin, who runs the website canadadrugshortage.com, said that many of the raw materials in the drug supply are made in China.
“Drugs get put together rather like cars get put together, from parts made all over the world,” she said. Even when the drug is assembled in North America, “The raw materials for making those drugs do come in a large proportion from China.”
In 2019, a representative from the U.S. Food and Drug Administration testified to Congress that drug manufacturing had increasingly moved out of the U.S.
Just 28 per cent of the facilities making active ingredients for the U.S. market were located in the U.S., the FDA said, with China accounting for 13 per cent, India 19 per cent, and the European Union, 26 per cent.
Canada is likely not much different, Duffin suggested.
“I know that very few of the drugs that are sold and used in Canada are made in Canada and consequently we are obviously going to be dependent. To what extent? I don’t know,” she said.
It hasn’t happened yet, though. While Canada currently has more than 2,000 ongoing drug shortages, none of them are related to COVID-19 problems, she said.
Barry Power of the Canadian Pharmacists’ Association says Canadian pharmacies aren’t noticing COVID-19-related trouble yet.
“To date, we haven’t heard of any increase in drug shortages,” he said. “The number that we’re seeing reported is pretty consistent with what we had at the end of 2019.
“It’s definitely a situation that we’re watching. However, there is a lot of potential for disruption of manufacturing, of the raw ingredients and some tablets and capsules and so on, manufactured in plants in China.”
He has, however, heard some reports from pharmacists of people buying up face masks — something he says doesn’t make sense as they’re not even very helpful against COVID-19.
“Our position is that masks aren’t needed. They’re not recommended by the Public Health Agency of Canada. So we really discourage people from trying to buy them,” he said.
People’s unnecessary mask purchases are causing shortages for those who do need them — dentists and other health professionals, he said.
Canada keeps a stockpile of essential supplies for emergency situations, which includes pharmaceuticals. Many warehouses also maintain a stockpile of medications, Power said.
Duffin thinks the current worries about COVID-19 are highlighting the need for more research into the causes of drug shortages, which she says can include everything from spikes in demand, to weather disasters, to international sanctions — especially in cases when key ingredients are made in a handful of locations with no back-up suppliers.
“It shows that these causes of drug shortages are international and multinational in their scope,” she said.
“If we’re going to get to the bottom of drug shortages, we really do need to start talking about it and we need to start talking to other countries.”
For now, Power says that Canadians shouldn’t worry about drug shortages as a result of the novel coronavirus.
“The COVID-19 crisis that we’re seeing right now in Canada is really more hype than reality at this point,” he said. He recommends talking to your pharmacist if you have concerns, as they can often recommend alternative medications.
“I think the main message in terms of the drug supply is, ‘Don’t panic.’”
“The worst thing that we can do is to start acting as if there is a shortage when there isn’t, because that will create spill-over effects and additional shortages of medications that are really crucial for many people in Canada,” he said.
— with files from Jackson Proskow, Global News and Reuters