Hurricane sends new shudders through health supply chain

Driving the news: Baxter's North Cove manufacturing site in Marion, North Carolina, is located in one of the areas hardest hit by the storm. It primarily makes intravenous and peritoneal dialysis solutions.

• "The heavy rain and storm surge triggered a levee breach, which led to water permeating the site," Baxter said, adding that bridges accessing the site were damaged.
• A spokesperson confirmed to Axios no one was injured in the 1.4 million-square-foot facility, which employs about 2,500 people, but that damage assessments are ongoing.
• "We are committed to helping ensure reliable supply of products to patients," Joe Almeida, CEO at Baxter, said in a statement. "Remediation efforts are already underway, and we will spare no resource — human or financial — to resume production."

But the closure illustrated yet again how taking a single plant offline can trigger a domino effect felt around the world.

• "It's a very serious situation," said Allan Coukell, chief government affairs officer for the hospital-owned drugmaker Civica Rx, which is addressing supply chain constraints within its consortium of health system and pharma members.
• "You really can't run a hospital very long without [IV bags] because fluid is not only used for managing all kinds of acute illness, but for delivering drugs for in surgery and inpatient care," Coukell said.
• Hospitals should be taking stock of inventories and starting workarounds, like having patients hydrate orally if they're able and manually pushing medications with syringes rather than an IV drip, said Mike Ganio, senior director at the American Society of Health-System Pharmacists.
• "We have strategies readily available based on our recent experiences that can be employed, and now it's just kind of waiting to see how much of an impact there is," he said.
• The Food and Drug Administration and the Administration for Strategic Preparedness and Response within the federal health department will play significant roles in the coming weeks. After past disasters, officials took steps including expediting reviews of drug applications that could help relieve shortages and prodding firms with FDA-approved saline products to add capacity.

The big picture: Extreme weather took another critical North Carolina drug plant offline last year, when a tornado heavily damaged a Pfizer facility that produced anesthesia and sterile injectables, idling the facility for 10 weeks.

• Seven years ago, Hurricane Maria roared through Puerto Rico, shuttering another Baxter production facility for IV solution and sparking widespread shortages and rationing.
• But it's not just the weather: The health system depends on a delicate ecosystem of plants that sometimes are the sole source of chemotherapy drugs, baby formula and antibiotics, as well as lower-cost generics.

Yes, but: Hurricane Maria and the COVID-19 experience led to a broad rethinking of how to plan around disasters, said Kyle MacKinnon of group purchasing organization Premier.

• Baxter has already been coordinating with federal agencies and group purchasing organizations. And the market is a bit healthier now than it was in 2017, with additional competitors in the IV fluid space, he said.
• "The call to action is going to be a conservation strategy for hospital leaders," MacKinnon said. "This is going to take some time, not only to, for the flooding and all the water to recede, if it hasn't already, but there's going to be the cleanup."

What we're watching: Whether the looming port worker strike magnifies disruptions.

• IV bags are particularly vulnerable because they are comparatively heavy, Coukell said.
• "You can put a lot of drugs on an airplane and get them here quickly," Coukell said. "A liter of saline weighs a kilogram and it is bulky. So you are limited in what you can bring by air."
• "If ports are closed, that is going to complicate the response," he said.