26 May Medicine shortages that affect our most vulnerable are unacceptable

Source: The Sun Herald

Opinion

A generation of women shied away from using treatments to ease the symptoms of menopause after a 2002 study linked hormone replacement therapy (HRT) with an increased risk of medical conditions such as stroke and breast cancer.

The hesitance to use HRT to provide relief from the hot flushes and night sweats triggered by declining levels of oestrogen as a woman ages remained until a 2019 Lancetpaper largely dispelled the concerns about the link to breast cancer.

This, coupled with more open discussion in the public domain about the experience of menopause, has seen an increase in the number of women prepared to use HRT, or menopause hormonal therapy.

Australia has entrenched medicine supply chain issues. But this combination of factors has led to an acute shortage of HRT patches which, as we report today, serves to highlight the wider problem in Australia with medicine supply.

There are about 420 medicines listed on the Therapeutic Goods Administration (TGA) Medicine Shortage Reports Database. The TGA receives an average of 120 notifications of new medicine shortages a month, with 12 of these having a critical impact rating.

In addition to HRT patches, other medications experiencing shortages are blood thinners, antibiotics and ADHD medication. The affected patient groups are often some of Australia’s most vulnerable.

The reasons why Australia experiences shortages are varied and complex but stem from our reliance on overseas suppliers as we import about 90 per cent of our medicines. As a consequence, we are extremely vulnerable to supply chain issues, such as the disruption that can be caused by natural disasters and our sheer geographic distance from manufacturers.

As one drug’s availability decreases, it increases demand on alternatives and so stresses another supply chain. Our small population limits our bargaining power to negotiate with overseas suppliers, and our existing local manufacturing capabilities hamper our ability to respond quickly at a domestic level to shortages.

This was in evidence last week with the shortage of diabetes drug Ozempic, also used as a weight-loss tool. Patients had been turning to replica weight-loss alternatives compounded by local pharmacists – but the government is banning those local versions from October over safety and regulation concerns, in a move backed by the TGA.

While no one can argue that patient health and safety should be compromised, the need to address these issues – especially our local manufacturing capabilities – is clear.

Our medication supply issues were especially pronounced during COVID, but medical industry figures warn that the problem is getting worse.

The federal government has taken some steps towards addressing our onshore healthcare manufacturing capabilities through its Future Made in Australia package, which includes investment in locally produced medicines and extra money for the National Medical Stockpile.

But the Royal Australasian College of Physicians wants to see that bolstered with a number of other urgent actions to alleviate the problems.

These solutions include creating a list of “critical, life-sustaining medications” to be developed, and minimum stock levels of those to be maintained, along with better tracking of stock levels.

The physicians’ peak body also wants the TGA to incentivise international suppliers of medicines to enter and remain in our market and for manufacturers to give the TGA advance notice of shortages and changes in supply.

As RACP president Professor Jennifer Martin warns, there is a major vulnerability in our healthcare system. “In addition to putting patients at risk of poorer clinical outcomes, medication shortages and discontinuations cause a great deal of anxiety for patients,” Professor Martin said.

“Serious concerns over health and quality of life are then left to our already overburdened physicians to manage.”

The Sun-Herald urges the federal government to heed these calls to ensure our most vulnerable are not paying the price for a systemic problem. As is summarised in our report today – at best, medicine shortages are inconvenient. At worst, they can be very dangerous.