Antibiotic, drug shortages highlight America's supply chain problems — again

Health systems and pharmacies are running out of antibiotics like amoxicillin and other commonly used drugs just as the worst flu season in more than a decade is colliding with RSV and a rebound of COVID cases.

Why it matters: It highlights the U.S. vulnerabilities, yet again, when it comes to its ability to supply some of the most basic health care products — even children's Motrin.

State of play: Antibiotics, antivirals and pediatric cold and flu medications are hard to find across the country as families deal with back-to-back illnesses spurring secondary effects like childhood ear infections and pneumonia.

• The problem started with manufacturers of antibiotics — companies like Hikma Pharmaceuticals, Teva and Sandoz — reporting shortages due to not anticipating the early surge of respiratory diseases and it escalated from there.

What they're saying: Health care providers now are "seeing the knock-on effect," Sarah Ash Combs, an emergency department physician at Children's National Hospital, told Axios. "Basically amoxicillin went on shortage so we upped our game and went to augmentin ... and that's now becoming on shortage."

• "That definitely affects us in the emergency department because these are the types of things we prescribe for kids to go home with and we get calls ... with the parent saying: 'I'm at my third pharmacy and they don't have amoxicillin. They don't have augmentin. What do I do?'"
• In Utah, stores are running out of children's Tylenol and pharmacists are trying to reformulate adult doses of antivirals like Tamiflu, Intermountain Healthcare doctors told Axios Salt Lake City last week.
• Parents have been calling, distraught over the trouble they've had securing everything from Children's Tylenol to amoxicillin to Tamiflu, Harni Patel, a pharmacist and owner of Tamarac Pharmacy in Fort Lauderdale, Florida, told the Tampa Bay Times.
• The surge of illness and the shortages of children's medications led the University of Kansas Health System to warn parents not to try to halve adult versions of the drugs, KMBC reported.

When parents see their kids sick, they feel desperate to do something and Motrin is typically the thing, Combs said.

• "And if I can't even say that, then I really have nothing to do for these children, which makes me feel terrible," she said.

The big picture: The shortages are being felt around the world, with providers in both the U.K. and Germany sounding the alarm and the EU investigating the chronic shortages, Politico reported.

Between the lines: This shortage isn't necessarily a supply chain problem, former FDA Commissioner and Pfizer board member Scott Gottlieb said on Face The Nation on Sunday.

• "This isn't like what we had with baby formula where manufacturers had been taken out of the market," Gottlieb said.
• "This is a sophisticated supply chain. All the manufacturers are in the market. They just didn’t anticipate this much demand this early in the season," he said.

Our thought bubble: This may be the symptom of an especially bad respiratory illness season. But it's hardly an anomaly.

• Some of the oldest, most basic supplies we depend upon — including products used in hospitals like saline for IVs, anti-inflammatory drugs or general anesthetics and even potentially game-changing new antibiotics — aren't big money makers for drug companies.
• That leads to unhealthy market dynamics such as offshoring their production, the loss of supply with the closure or disruption of a single manufacturer or drugs being controlled by so few players that companies can demand soaring prices for old drugs.

When it comes to antibiotics, concerns about these shortages and the broken marketplace has renewed interest in a bill known as the Pasteur Act that's been a decade in the making, the New York Times reported.

• The bill would create a $6 billion Netflix-style purchasing arrangement in which drug companies would get an upfront payment for the development of new antibiotics from the government in exchange for unlimited access upon FDA approval, per the Times.

What to watch: The supply chain shortages even stretch beyond antibiotics or common children's medicines, but even have impacted albuterol, Combs said.

• It's "the mainstay of asthma rescue medication," Combs said. "This isn't something that's a brand name and we just have to shift to something slightly different. This is the generic. This is the medicine."

The bottom line: It's an example of how these intermittent health care shortages can happen concurrently or even cascade on each other, making the need for fixing America's pharmaceutical market that much more pressing.