COVID-19 and the prevalence of drug shortages in Canada: a cross-sectional time-series analysis from April 2017 to April 2022

Abstract

Background: In March 2020, the Government of Canada introduced measures to reduce intensifying shortages of prescription drugs during the beginning of the COVID-19 pandemic. We sought to assess the extent to which a decline in drug shortages was observed in the months after this policy change. Methods: Our data source was the Drug Shortages Canada Database, which reports shortages by drug product, including shortage start and duration. Using a cross-sectional design, we tracked shortage rates of drug products using a 30-day moving average from Apr. 15, 2017, to Apr. 1, 2022. We used autoregressive integrated moving average modelling with a ramp function to determine the significance of trend changes after policy implementation. Results: We found that of the 13 329 drug products at risk for shortage, 44.7% ( n = 5953) had at least 1 shortage event in the past 5 years. Average daily shortage prevalence rates rose from 901 in April 2017 to a peak of 2345 by April 2020. Significant declines ( p = 0.02) ensued shortly thereafter, dropping to a rate of 1611 shortages by the end of the first year after policy implementation. However, we did not observe a significant reduction in shortage rates in the second year ( p = 0.2), with rates plateauing below 1500 and then rising back above 1600 by the end of March 2022. Interpretation: Drug shortages are common in Canada, including during the initial months of the COVID-19 pandemic. We observed substantial improvements after the implementation of the new measures, but gains appear to have plateaued. Continued vigilance is needed to sustain improvements.

Drug shortages. Part 2: Trends, causes and solutions

“…A similar approach in response to the pandemic has been described in Canada, where the Government announced in 2020 that it would license companies to make generic copies of brand‐name products without having to negotiate with patent holders and compensate patent holders after the fact; this was made possible by amendment of the Patent Act under Canada's COVID‐19 Emergency Response Act 61 . This seems to have been at least partly effective in reducing shortage rates 16 …”

“…61 This seems to have been at least partly effective in reducing shortage rates. 16 During shortages, limits on dispensing and sales at pharmacies do not solve the problem but make equitable access more likely. 62,63 In recent years several reports have made recommendations on how to prevent and deal with shortages.…”

“…In the United Kingdom, over 900 formulations have been in short supply since 2014 for periods of weeks to months, some indefinitely 15 . Shortages have also occurred during the recent pandemic, 16 and shortages continue to be reported from time to time worldwide. Recent examples include shortages of 30 brands of hormone replacement therapy (HRT), 17,18 of temazepam 19,20 and of amoxicillin 21,22…”

Queering Public Health: A Critical Examination of Healthcare Access and Gender Expression among Trans, Nonbinary, and Other Gender Nonconforming People during COVID-19

“…Participants experienced multiple disruptions to gender-afrming care during the frst three waves of COVID-19 in Canada [18]. COVID-19 lockdowns and travel restrictions afected the supply chain for medications nationwide [52,53]. For our participants, this impacted their ability to access hormone therapy.…”

The impact of the coronavirus pandemic on sedation in critical care: volatile anesthetics in the ICU

“…The need for sedation is largely guided by two factors: enabling patient tolerance of an endotracheal tube and other invasive procedures, and suppressing a patient's drive to breathe in order to limit tidal volumes and reduce ventilator-induced lung injury. Low supply of sedative agents along with many other drugs stemmed from disruption of drug supply chains in China and India that are pivotal in the production of the active ingredients of many agents [ 10 ]. Drug shortages are not a new phenomenon [ 11 ], but the universal surge in demand for the same sedative therapeutics, rapid change in drug purchasing patterns, scaling up and shipping problems led to major drug shortage crises [ 12 ].…”