Poor hospital supplies could spell danger for vulnerable patients

By Dr. Ananya Mandal, MDSep 29 2011

It was found that most hospitals operate with less than a month's supply of many essential medicines, leaving patients vulnerable if local distributors are unable to import them through fragile international supply chains.

This came when the sole supplier CSL revealed that it would be unable to import intravenous penicillin until December. But an analysis by a Newcastle doctor, Simon Quilty, suggests many opioid painkillers, anesthetics, HIV drugs and cancer chemotherapies are stocked at less than 30 days' supply, making them equally vulnerable to manufacturing disruptions.

Dr Quilty said shortages of life-saving medicines were “an increasing threat to public health … the true problem is unrecognized here and escalating internationally”. His conclusions are based on an audit of hospital pharmacies in the Hunter, which found among 378 medicines classed as essential under World Health Organization criteria, a quarter were stocked at less than a month's reserve while for 3 per cent there was less than a week's supply.

HIV and cancer drugs were held in low supply in “a reflection of pharmacy policy designed to reduce cost and expiry of expensive medicines with short shelf lives,” Dr Quilty wrote in a paper published online yesterday by the Medical Journal of Australia. But Australia, which the Productivity Commission found made less than 5 per cent of the medicines it used, was at the mercy of the global drugs market, and supply could be affected by natural disasters or wars. :For many medicines, there are only a few sites worldwide, mainly in India and China, that manufacture [ingredients],” he wrote. Industry secrecy meant it was hard for regulators to trace the ultimate origin of imported medicines, and to anticipate likely supply problems, Dr Quilty added.

Yvonne Allinson, the head of the Society of Hospital Pharmacists of Australia, said state and federal governments should co-operate to ensure viable supplies of essential drugs were maintained. The federal Department of Health and Ageing already keeps a national medical stockpile, which it calls a “strategic reserve of essential vaccines, antibiotics and antiviral drugs, and chemical and radiological antidotes”.

But Ms Allinson said a virtual stockpile, held at hospitals, would allow drugs to be rotated into active use before their expiry and reduce the cost of maintaining appropriate reserves. “I think this is a situation we're going to face more often now we have a global marketplace for medicines,” she said.

Brendan Shaw, the chief executive of the pharmaceutical lobby group Medicines Australia, suggested government should be prepared to pay extra to ensure medicines came from a sustainable manufacturing source. Current purchasing policies discouraged companies from manufacturing in Australia, and incentives to encourage local research had been eroded.

A spokeswoman for the Department of Health and Ageing said there were already “well-developed processes to ensure an adequate supply of essential medicines in the Australian market”, but temporary shortages were not uncommon. In such cases the Therapeutic Goods Administration has identified an international supplier and is working with Australian drug companies to import and fast-track a new supply of the medicine into the country within weeks.