Jun 15, 2023 - Podcasts

A critical shortage of cancer drugs in the U.S.

Some chemotherapy drugs are currently in such short supply in the U.S. that doctors are going to extreme lengths to get patients the treatments they need. The shortage is fueling new calls to fortify the U.S. drug supply chain.

  • Plus, the Fed ends its rate hike streak.
  • And, record numbers of people have been forcibly displaced worldwide.

Guests: Axios' Tina Reed, Matt Phillips and Laurin-Whitney Gottbrath.

Credits: Axios Today is produced by Niala Boodhoo, Alexandra Botti, Fonda Mwangi, Lydia McMullen-Laird and Alex Sugiura. Music is composed by Evan Viola. You can reach us at [email protected]. You can text questions, comments and story ideas to Niala as a text or voice memo to 202-918-4893.

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NIALA: Good morning! Welcome to Axios Today!

It’s Thursday, June 15th.

I’m Niala Boodhoo.

Here’s what we’re covering: the Fed ends its rate hike streak. Plus: record numbers of people have been forcibly displaced…worldwide.

But first, a critical shortage of cancer drugs in the U.S. That’s today’s One Big Thing.

NIALA: Some chemotherapy drugs are currently in such short supply in the US that doctors are going to extreme lengths to get patients the treatments they need. And Axios healthcare editor Tina Reed says the shortage is fueling new calls to fortify the US drug supply chain. Tina, first, when did this start?

TINA REED: So the American Society of Health System Pharmacists first reported the cisplatin shortage, which is a chemotherapy drug back in January. And then another chemotherapy drug known as carboplatin was in shortage starting in March. And this all goes back to a particular factory in India that makes both drugs, which had a halt production after an inspection flagged some quality concerns.

NIALA: And all of this, this shortage has gotten so bad for these drugs because of one facility in India?

TINA: Really what a lot of folks are talking about right now is that this is an example of some of the problems that we have in our drug supply system right now. These cancer drugs are, generic drugs. They're used for a lot of cancers. They're highly effective. But they're not very lucrative for drug companies because they're pretty inexpensive. And so there's only a few manufacturers that make them. So if one goes down, the others need to catch up with the supply, and that's where we run into problems.

NIALA: Tina, can you give us a sense of just how critical these drugs are for patient care,

TINA: So this week there was actually a doctor who testified in front of Congress talking about the impact this makes for instance, in patients with metastatic testicular cancer. One of these drugs can be curative for people who have had this cancer spread throughout their body. However, there's not a good alternative if they can't get that drug. And so they can have a much worse outcome if they get a delay of that drug or they can't get it at all.

NIALA: So what are doctors doing right now?

TINA: They're rationing care in some cases. Or they may be asking patients to drive long distances to get treatment if one cancer center is completely out of these drugs, or they are turning to alternative treatments that may come with riskier side effects.

NIALA: Tina, you mentioned congressional testimony. How is Congress getting involved here, or are lawmakers trying to help solve this issue?

TINA: there's a number of ideas members of Congress are kicking around, including whether or not they might be able to give the FDA authority to order manufacturers to report sharp increases in demand, uh, that could prompt a shortage, requiring stockpiling of critical drugs, requiring more transparency when it comes to what their suppliers are. Right now there's a little bit of debate in Congress about exactly how to go about that, but there does seem to be a consensus that there needs to be something done to better incentivize this part of the drug supply chain and figure out what it would take to ensure we don't continue having these shortages.

NIALA: Tina, if this is something that may not be solved by market forces, if it's not lucrative enough for companies to produce this, how could we fix this supply chain issue?

TINA: Speaking with experts, there's a number of different ways that the market might be better stabilized for the manufacturers who are playing in this space. In one example, Civica RX is a, a nonprofit model that was actually, created to try to, create a stable, production of certain drugs that were used in hospitals that were often going on shortage. And they said the the ingredients they really needed were predictable demand, a fixed price so that they could better create a model that would make money for the manufacturer as well as produce that reliable supply. they also will stockpile, about six months worth of drugs so in the event that maybe their suppliers run short, if there's a reason they might, have a shortage, they're ready for it.

NIALA: Tina Reed is Axios' Healthcare Editor. Thanks, Tina.

TINA: Thank you, Niala.

NIALA: Yesterday, the Fed’s Open Market Committee announced it wasn’t hiking interest rates - ending their streak of ten straight increases. So I asked Axios Markets’ Matt Phillips – is the Fed done raising rates?

MATT: Well, Niala, it's a little bit tough to say conclusively, which was the, the big takeaway from, from, uh, the Fed's comments yesterday, they stand ready to kick back into rate hiking form if inflation, doesn't keep falling or if it reaccelerates.

So basically it's a pause. This string of 10 straight interest rate increases lifted interest rates by five percentage points over the last 18 months. That's basically the sharpest increase in about 40 years. We have seen inflation start to come down a little bit, and there are tentative signs that the job market, which has been an important part of the inflation story, is starting to soften a little bit.

So, they are betting that they can take a break. They don't wanna overtighten too much and push us into like a deep recession by accident. So they're going to take a breath, let more data come in over the next few months before they have to make another decision about interest rates and just see where we are.

In a moment, forced displacement around the world…reaches a record high.

NIALA: Welcome back to Axios Today I'm Niala Boodhoo.

The number of people displaced by war, persecution, violence, and human rights abuses around the globe has reached a record high around 110 million.

FILIPPO GRANDI: It's quite an indictment on the state of our world, if I may say, to, uh, have to report that.

NIALA: That's the UN High Commissioner for refugees, Filippo Grandi, talking to reporters this week in Geneva about the agency's new global trends report. According to that report at the end of last year, around 1 in every 74 people on Earth had been forced to flee their home.

Axios Laurin-Whitney Gottbrath is here with the big picture. Welcome back LW.

LAURIN-WHITNEY GOTTBRATH: Thanks for having me.

NIALA: The exodus from Ukraine is the fastest growing refugee crisis in Europe since World War II. What other factors besides war are leading to this record breaking number?

LW: A big one is climate change. Thousands, if not millions of people in certain places have been displaced, either within their own country or have been forced to flee, to other countries, mostly to escape either flooding, or, drought, which is producing, you know, a hunger crisis and, and parts of Africa, uh, and other things. So that's also a major factor that's becoming increasingly worse as time goes on.

NIALA: LW, what's the difference between a refugee or a displaced person?

LW: So refugees are, folks who are fleeing across their national borders. 52% of refugees come from just three countries, around the world. The top is Syria, there's been a more than decade long war happening in Syria. And obviously Ukraine is another, and then Afghanistan. Internally displaced people or IDPs, as they're often referred to, are folks who have fled their homes, but they've never crossed an international border. And I think what a lot of people don't understand when they're looking at displacement worldwide is, IDPs actually make up the largest percentage of displaced people in the world. At the end of 2022, 58% of displaced people were IDPs.

NIALA: We see a lot of headlines about refugees or displaced people coming to Europe or the U.S. Gut actually about 76% of refugees and other people in need of international assistance are actually hosted by low and middle income nations. Which countries are these?

LW: Yeah, so these countries include Turkey, Iran, Columbia, Germany, and Pakistan. Obviously you do have some higher income countries in the, in those sort of top ones, but you do have low and middle income countries as well. And the important thing to remember is people who are fleeing generally, flee to neighboring countries. For many of these people, the ultimate goal is to return back to their home. We're seeing that today in Sudan, for example a lot of Sudanese people fled to Egypt, to Chad. So I think it is sort of a misnomer, particularly in the West, that a lot of refugees in particular are fleeing to the west. And that's just not the case when we look at the numbers. And I think that's something that often sort of gets lost in political dialogue around refugees and asylum and other things.

NIALA: How are these displaced people being received? Does it depend on the country?

LW: Absolutely. And we saw that especially last year when it came to Ukraine, many countries throughout the world were lauded for their reaction response to Russia's invasion of Ukraine, welcoming Ukrainian refugees with open arms. Sadly we don't see the same thing happening for a lot of other countries. I mean, we can look at this year's example of Sudan, we're seeing pushbacks, we're seeing people expelled. And really we're seeing a sort of tightening, of restrictions on refugees, particularly from these other parts of the world. And, you know, human rights groups, that's one thing they continue to point out time and time again. They don't wanna diminish the response to Ukraine. But people deserve, the same level of respect and dignity that I think people responded to when it came to Ukraine

NIALA: Laurin-Whitney Gottbrath edits Axios’ World News. Thanks LW.

LW: Thank you.

That’s all we’ve got for you today!

I’m Niala Boodhoo - thanks for listening - stay safe and we’ll see you back here tomorrow morning.

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