{"id":572505,"date":"2023-03-21T19:57:28","date_gmt":"2023-03-21T16:57:28","guid":{"rendered":"https:\/\/en.buradabiliyorum.com\/the-big-idea-stockpile-canadas-drugs\/"},"modified":"2023-03-21T19:57:28","modified_gmt":"2023-03-21T16:57:28","slug":"the-big-idea-stockpile-canadas-drugs","status":"publish","type":"post","link":"https:\/\/buradabiliyorum.com\/en\/the-big-idea-stockpile-canadas-drugs\/","title":{"rendered":"#The Big Idea: Stockpile Canada\u2019s Drugs"},"content":{"rendered":"
\n The pandemic\u2014and one very bad winter\u2014have exposed long-standing gaps in Canada\u2019s pharma supply. We can\u2019t get caught off-guard again\n <\/div>\n
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(Illustration by Pete Ryan)<\/p>\n<\/div>\n

Shoo Lee <\/span><\/em>is professor emeritus at the University of Toronto and former pediatrician-in-chief at Mount Sinai Hospital in Toronto. He was named to the Order of Canada in 2019.<\/i><\/p>\n

Last summer<\/span>, my colleagues and I published a paper in the Canadian Medical Association Journal<\/i>, insisting that pharmaceutical security needed to become a national priority. Months later, we saw why: in the midst of a \u201ctrip<\/a>ledemic\u201d of COVID, flu, and respiratory syncytial virus, or RSV, panicked parents scoured pharmacies for children\u2019s Tylenol and found only empty shelves. Sick adults couldn\u2019t get their hands on over-the-counter cold medicines. Out west, the antibiotic amoxicillin was scarce.<\/p>\n

As Canadian health-care professionals<\/span> know, this was an extreme example of an old issue. One quarter of all Canadian drugs (over-the-counter and otherwise) were <\/span>running short well before the pandemic, but there\u2019s nothing quite like a global health crisis to expose a country\u2019s weak points. To make sure shortages like this don\u2019t keep happ<\/a>ening, we need a plan\u2014and the political will\u2014to keep at least six months\u2019 worth of critical drugs stocked on home soil at all times.<\/p>\n

Canada\u2019s fundamental problem, for a \u200b\u200blong time, has been one of foreign depen\u200bdence. The world of pharmaceuticals is at<\/span>tached to a hugely complex supply chain, one that\u2019s easily disrupted by geopolitical problems (like wars), shipping issues (like high fuel costs) and, of course, viral outbreaks (like <\/span>COVID-19). On top of that, the majority of the active pharmaceutical ingredients, or APIs, needed to make drugs are produced in India and China. And many brands are only supplied by one or two companies. One such drug is Clavulin, an oral antibiotic for children that was recently in short supply.\u00a0<\/span><\/p>\n

In the past decade, the percentage of Canada\u2019s drug spending allocated to imports rose from 74 to 93 per cent, making us especially vulnerable to supply cut-offs. As we saw with COVID vaccines, countries with their own production facilities will always prioritize getting treatments to their own citizens. If your drug-acquisition<\/span> strategy relies heavily on imports, as ours does, you need mechanisms in place to protect yourself.<\/p>\n

The good news<\/a> is that Canada has run into this problem\u2014and solved it\u2014before. In the 1940s, most of our drugs were sourced from outside of the country. (For a while, we also paid some of the highest drug costs in the OECD.) To fix this issue, in 1969, the federal government amended the Patent Act to allow Canadian companies to manufacture patented drugs by paying royalties to brand-name pharmaceutical companies. This resulted in huge growth in Canada\u2019s own pharmaceutical industry. But with the rise of free-trade agreements, like NAFTA, we buckled under external pressure to reverse that policy. Our companies could no longer compete; many of them went bankrupt or were bought out by overseas firms. To this day, Apotex is the only remaining large manufacturer of generic drugs in Canada.\u00a0<\/span><\/span><\/p>\n

The best short-term solution Canada has for its current drug-supply problem is one we can copy from our neighbours. At the outset of the pandemic, the World Health Organization called on all countries to create a list of essential medicines\u2014one that would ensure citizen access to critical drugs. Down south, the Trump administration issued an executive order to the FDA to compile a list of 227 must-have medi<\/span>cines, like aspirin and morphine, as well as their proper dosage methods.\u00a0<\/span><\/p>\n

In Canada, we have no such list, aside from the 12 medicines declared critical by Health Canada during COVID, which <\/span>include epinephrine and fentanyl. Drawing up our own list isn\u2019t exactly rocket science<\/a>: Health Canada simply needs to convene a panel of experts\u2014pharmacists, doctors and representatives from the various provincial ministries of health\u2014to decide which drugs should make the cut. For the most part, running out of something like cold medicine is an inconvenience. But people with more serious illnesses, like cancer, can\u2019t afford to wait six months for a restock of oncology drugs. I\u2019d also add things like anesthetics, epidurals, antibiotics and drugs used for diagnostic imaging to the list. Canadians and <\/span>Americans have similar medical needs; we could very well use the FDA\u2019s template as a starting point.<\/span><\/p>\n

Once we know which drugs to prioritize, we need a more efficient way of stockpiling them. Like us, the European Union was crippled by a surge in sickness last winter; they began drawing up its own stockpiling plans back in January. Canada already has its own National Emergency Strategic Stockpile, or NESS, which is managed by the Public Health Agency of Canada. It\u2019s available for the provinces and territories to dip into during emergencies. Unfortunately, it\u2019s also riddled with problems. Back in 2010, an audit revealed that many of the NESS\u2019s supplies were expired\u2014some dating as far back as the 1960s. NESS was also short on much of the personal protective equipment we needed at the height of COVID. This cannot happen again.<\/p>\n

A six-month stockpile of critical medicines should be readily available for distribution. To keep track of it, Health Canada (or some related federal department) needs to create a more rigorous internal inventory, one that\u2019s digitized and updated in real time with every replenishing shipment or change in drug quantity. Another idea is to store the medicines in warehouses owned by the drug manufacturers themselves. The downside of this is that, in order to pay for the extra space, the government may have to allow producers to increase their drug costs. (To me, this provision is worth the price\u2014<\/span>especially in a resource-rich country like Canada.) To ensure the stockpile is always full, the federal government could establish <\/span>a Crown corporation to manufacture these essential drugs. In the event of a national shortage\u2014which, sadly is certain to occur again\u2014production can be ramped up to meet demand.\u00a0<\/span><\/p>\n

The long-term strategy is to create a thriving pharmaceutical industry at home. There are reasons to be hopeful: Moderna planted roots in Quebec back in 2020, with the eventual goal of producing 100 million mRNA vaccine doses <\/span>every year. Last winter, Quebec\u2019s Mantra <\/span>Pharma distributed its first domestic shipment of M-Amoxi Clav\u2014a generic of <\/span>Clavulin. And researchers at the Universit\u00e9 de Montr\u00e9al are pioneering new technologies that could streamline the output of APIs, allowing manufacturers to more efficiently scale up production when our drug supply runs too low. Some people will say that Canada is simply too small a market to compete internationally, but we\u2019ve done it once before.\u00a0<\/span><\/span><\/p>\n

Canada again has some of the highest drug costs in the OECD, third behind the U.S. and Switzerland. We need to stop paying through our noses\u2014and looking elsewhere\u2014for medications that are essential to Canadians\u2019 livelihoods. Young children shouldn\u2019t be running fevers because we can\u2019t secure something as simple as children\u2019s Tylenol, and our solution can\u2019t be to order two million bottles to get parents to stop complaining. We can\u2019t wait for the next war\u2014or pandemic-sized meltdown\u2014to motivate us. We should always be prepared.<\/p>\n<\/p><\/div>\n