War risks ripple through global drug supply

As the conflict in the Middle East disrupts fuel, shipping and food supplies, many are starting to ask if they will be still be able to get their medicines if the war drags on. Australia's medicine supply chain is built to handle short disruptions. So you shouldn't have problems accessing most common medicines in the short to medium term. But it isn't designed for prolonged global instability.

What's in place to protect our medicine supply?

Since July 2023, Australia has had specific stock-holding requirements for many medicines the government subsidises on the Pharmaceutical Benefits Scheme (PBS). It means manufacturers must hold at least four or six month' worth of stock of these medicines, depending on the particular medicine, on Australian soil.

This creates a buffer. If a shortage begins, it gives the Therapeutic Goods Administration (TGA), our national medicines regulator, time to respond and reduce the impact. These medicines aren't stored in a single warehouse. They're spread across wholesalers and pharmacies.

This helps ensure access across the country, including in regional areas. The list of medicines covered is reviewed regularly and another review is due this month. This means regulators can adjust which medicines are prioritised as global conditions change.

However, this protection does not apply to every medicine. If a medicine is not listed on the PBS, the risk of shortages increases. This includes newer medicines and those only available on private prescription. These medicines often have smaller stock buffers and fewer suppliers so they are more vulnerable when supply chains are disrupted.

What about existing shortages?

Australia has been dealing with medicine shortages for several years. Common causes include manufacturing problems such as difficulty sourcing raw ingredients and sudden increases in demand for medicines. There have been ongoing shortages of attention-deficit hyperactivity (ADHD) medicines lisdexamfetamine and methylphenidate, for example, due to global demand and production limits overseas.

Some antibiotics and hormone replacement therapies have also been affected by manufacturing disruptions. High demand for weight-loss medicines has also affected supply.

Where do our medicines come from?

Australia produces some medicines and vaccines locally, but we are not self-sufficient. Even when medicines are made here, the raw ingredients are often imported. Overall, more than 90% of medicines used in Australia come from overseas.

The main sources of medicines are the United States, Europe, India and China. India and China are especially important because they manufacture many of the raw ingredients used to make medicines. Even the US depends on these supply chains, which then affects countries such as Australia.

This is where the system becomes fragile

Medicine supply chains are less like a straight pipeline and more like a spider's web. Their strength depends on every strand of the web being intact. One strand might be a factory in India. Another could be a shipping route through a conflict zone. Another is a wholesaler in Australia. If one strand breaks, the system does not collapse immediately, but it weakens.

When several strands are disrupted at once, the effects ripple across the network. War can disrupt this web in multiple ways. Shipping routes may be blocked or delayed. Air transport can be restricted. Access to raw materials may be limited.

Manufacturing can slow down. Even in Australia, fuel shortages could affect how medicines are transported between cities and pharmacies. War is one risk. Natural disasters, pandemics and even panic buying can all place additional pressure on supply.

(The writers are associated with the Adelaide University, Melbourne, Australia)