Before Hurricane Maria hit, many people did not know Puerto Rico housed 89 facilities that manufacture pharmaceutical drugs and medical devices. The island's $60 billion infrastructure is now severely compromised, as we begin to learn more about the damage done.
Puerto Rico's pharmaceutical sector — an industry that employed 90,000 workers — has suffered devastating job losses since the storm. We also have the crippling effect on island and mainland hospitals as they grovel to meet medical demands amid employee, power, water, drug and medical device shortages.
This past week, the House Energy and Commerce Committee questioned Food and Drug Administration (FDA) Commissioner Scott Gottlieb about the drug and medical device shortage. In prepared remarks on Oct. 23, Gottlieb confirmed that there are "many firms operating around 20 percent capacity, and some even less. We have found no firm operating above 70 percent of their normal operation."
Given this rapid shift in drug and device production, Gottlieb also confirmed fears that the slowdown challenges of recovery and relocation may lead to future shortages.
"I don't think we’ve dealt with a situation where we've had so many simultaneous impacts to what are very important facilities," he said.
What are some of the most impacted drugs and devices? Currently, the FDA has its eye on 30 drugs and medical devices. The New York Times reports that devices like Aspen Medical's surgery scalpels, Davol's hernia mesh and Baxter's popular "Mini-Bag" are in short supply.
The Mini-Bag is a small, fluid-filled bag used to dilute drugs and drip them into people's veins. It is so popular that hospitals are scrambling to find alternatives.
Prominent companies like Johnson & Johnson are now acknowledging potential shortages. Two popular Johnson & Johnson drugs made in Puerto Rico are Tylenol and the HIV. drug Prezista.
According to the company website: "While we cannot rule out the potential for intermittent shortages of certain product formats, many of our products have dual production sites and backup supply channels outside of Puerto Rico to help meet demand."
What can hospitals do to address inevitable supply-side shortages? In addition to companies revealing more information to the public through media events and on their websites, the FDA has stepped in with various resources to help hospitals prepare for shortages.
In 2013, the FDA implemented a Safety and Innovation Act and Strategic Plan for Preventing and Mitigating Drug Shortages. According to the FDA, this plan prevented 170 new shortages that year.
Also, the FDA website includes a Drug Shortage Database page where medical personnel can research drug and device availability and report shortages. News reports in the past few days corroborate that hospitals are not receiving necessary supplies due to Maria's impact.
Confirming that both morphine and ringer IVs are in short supply, University of North Carolina Medical Center spokesperson Alan Wolf stated that shortages are always a challenge. Maria has just made the challenge worse.
"UNC Medical Center has contingency plans in place, and a team of people [is] working daily to find new sources for some supplies, implement conservation measures and use alternative medical products when possible," Wolf told WRAL-TV.
Another North Carolina-based hospital, Moses Cone, has convened a task force to ensure patients do not experience any extra pain amid a shortage of "close to 200 drugs." Granted, not all of these drugs are used frequently, but 200 is still a notable number.
Prior to the recent hurricanes, already-existing sources have produced advice to guide organizations through what some have referred to as the "Drug Shortage Era."
Convening task forces, researching new sources, conservation of existing products, and finding product alternatives are all prominent hospital survival strategies in the post-Maria medical climate. Only time will tell if this will be enough to avoid an exacerbated drug and device shortage affecting patients on the island and the mainland.
