No one yet knows the consequences of the coronavirus “Global Health Emergency.” That’s what the World Health Organization now calls it. When we first wrote about this epidemic on Jan. 27, 2020, there were less than 3,000 cases and fewer than 100 deaths. Three days later (Jan. 30, 2020), there were 8,200 cases and more than 200 deaths. On Feb. 1, 2020, the number of cases exceeded 12,000 and deaths were approaching 300. By Monday, Feb. 3, 2020, the case count was over 17,000 and deaths were over 360. All but one of the deaths took place in China. Many planes have stopped flying into or out of China. This coronavirus chaos could lead to worldwide drug shortages! Could that become a health catastrophe quite separate from the prospect of rapid transmission of the virus?
Why Might There Be Worldwide Drug Shortages?
Consider this. China is a major supplier of active pharmaceutical ingredients (APIs) throughout the world. What is an API you might ask? An API is the key ingredient (raw material) in any medication. Take the brand name antidepressant Prozac. The active pharmaceutical ingredient is fluoxetine (the generic drug name). Its chemical name is N-methyl-3-phenyl-3-[(α,α,α-trifluoro-p-tolyl)oxy]propylamine hydrochloride. Yes, that is a mouthful.
Here is the molecular formula of fluoxetine hydrochloride: C17H18F3NO•HCl
There are almost always “inactive” ingredients in the pill or capsule along with the API. These are called excipients. They include binders, fillers, colors, etc.
In addition to APIs, China makes finished pills and ships them around the world. China also sells active pharmaceutical ingredients to generic drug makers in India and other countries. It has been estimated that pharmaceutical companies in India rely on China for 70 to 75% of the APIs that are used there to manufacture finished drug products.
What About Tariffs on China?
You may remember that the United States imposed significant tariffs on a tremendous number of Chinese products. Why, might you ask, were “pharmaceuticals, certain pharmaceutical inputs, and select medical goods” excluded?
Some insiders speculate that tariffs on pharmaceuticals might have disrupted the pharmaceutical supply chain in the United States. Whatever the reason, pharmaceuticals were excluded from embargoes or tariffs.
What Would Happen If APIs Stopped Flowing from China?
At this early stage in the coronavirus epidemic, no one knows if we are facing worldwide drug shortages. What we do know is that most airplane traffic into and out of China has been restricted if not suspended. Whether that applies to pharmaceuticals we don’t know.
We suspect the same thing is happening to other forms of transportation, including shipping. That could mean that Chinese APIs and pharmaceuticals are no longer flowing smoothly to India, Thailand, Brazil, Slovakia or the U.S. A colleague is on the ground in India. He carefully monitors Indian drug manufacturing issues. Today he told me that:
“I am already seeing some panic among drug formulation manufacturers about significant disruptions in their supply chain.”
Worldwide Drug Shortages Already Exist:
Drug shortages are nothing new. Even before the coronavirus chaos, health professionals have been dealing with worldwide drug shortages. The FDA sends out a list of drug shortages almost every week. Here is a link to the most recent list.
You will see that the frequently prescribed blood pressure pill diltiazem is on that list. So is the life-saving injection, epinephrine. The injectable anesthetic drug ketamine is also “currently in shortage.” The anti-seizure medicine for epilepsy, levetiracetam, is in the same situation.
Worldwide drug shortages are already a crisis. All the FDA can do is list drug shortages on its website. The agency has no solution for existing shortages of critical medicines.
If the coronavirus epidemic leads to massive shortages in APIs, then worldwide drug shortages are sure to follow. You may want to stock up on critical medicines before we discover that this nightmare is actually unfolding.
Is the Coronavirus Chaos All a Tempest in a Teapot?
Many readers of our newsletter think the coronavirus scare is much ado about nothing. Here are just a few comments in response to our recent article:
Coronavirus Freak Out: Is It Justified or Overblown?
Coronavirus is capturing headlines. The World Health Organization just declared it a global health emergency. Is the coronavirus freak out justified?
Comments From Readers On Jan. 31, 2020:
Pam says:
“The media hype will continue, no matter what. It’s too bad we never know when to believe them.”
Judi suggests that a positive attitude is the answer:
“When you dwell in fear you attract what it is that you fear. Eat healthy, think positive and enjoy your life.”
Linda seems to imply the China virus story is fake news and links to a blog by Jon Rappoport that says in part:
“You automatically believe this Chinese coronavirus is a killer? You automatically believe the press when they ratchet up the fear? You automatically believe medical experts have found a virus and proved it’s causing human illness?
“You’re on the Gong Show on roller skates.”
Lyn, on the other hand, is concerned:
“The CDC and NIH are in denial, while the WHO has declared a Global Health Emergency. It would behoove people to take precautionary measures and stay out of harm’s way, as I feel this is just the tip of the iceberg where the coronavirus is concerned. I hope that it doesn’t turn into a pandemic.”
Are There Any Valid Scientific Projections About Coronavirus?
An intriguing article appeared in the highly credible medical journal, The Lancet (Jan. 31, 2020).
This research represents a modeling study based on available data:
“Authors caution that given the lack of a robust and detailed timeline of records of suspected, probable, and confirmed cases and close contacts, the true size of the epidemic and its pandemic potential remains unclear.”
That said, here are their projections about the new coronavirus (2019-nCoV):
“In our baseline scenario, we estimated that the basic reproductive number for 2019-nCoV was 2·68 and that 75,815 individuals have been infected in Wuhan as of Jan 25, 2020. The epidemic doubling time was 6·4 days.”
The researchers conclude:
“In this study, we have estimated the outbreak size of 2019-nCoV thus far in Wuhan and the probable extent of disease spread to other cities domestically. Our findings suggest that independent self-sustaining human-to-human spread is already present in multiple major Chinese cities, many of which are global transport hubs with huge numbers of both inbound and outbound passengers (eg, Beijing, Shanghai, Guangzhou, and Shenzhen).
“Therefore, in the absence of substantial public health interventions that are immediately applied, further international seeding and subsequent local establishment of epidemics might become inevitable. On the present trajectory, 2019-nCoV could be about to become a global epidemic in the absence of mitigation.”
The People’s Pharmacy Perspective:
The next few weeks will be critical in determining the extent of this epidemic. If the number of people infected with the coronavirus was actually 75,815 on January 25, 2020, instead of the official Chinese report of under 3,000, we could be in for a disaster of untold dimensions.
We certainly hope that the number of cases of coronavirus infection in China begin to taper off. If that does not happen, however, we would encourage people who must take essential medications to make sure they have an ample supply on hand. If a prescription is about to run out, this might be a good time to contact the pharmacy or physician and get a refill.
Share your thoughts about the possibility of worldwide drug shortages in the comment section below.
Help a Friend:
Do you know someone who takes medications on a regular basis? People who need drugs for epilepsy, hypertension, depression, infection, hypothyroidism, diabetes, cancer, autoimmune disorders and so many other serious conditions cannot afford to run out. Please share this article with friends, family members and coworkers. Being prepared for the possibility of drug shortages could make a big difference in someone’s life.
