Critical Drugs for Critical Care: Protecting the US Pharmaceutical Supply in a Time of Crisis

Mariana P. Socal, MD, PhD; Joshua M. Sharfstein, MD; Jeremy A. Greene, MD, PhD


Am J Public Health. 2020;110(9):1346-1347. 

In This Article

Abstract and Introduction


Epidemics shine a bright light on the weak spots in our social structures, and in recent months COVID-19 has pointedly exposed the fragility of the US pharmaceutical supply chain. A single announcement from the White House prematurely claiming the safety and efficacy of hydroxychloroquine (Plaquenil) as a "game changer" for COVID-19 infection was enough to trigger a shortage of this drug.[1] Hospitals treating severe COVID-19 cases now face significant challenges in maintaining supplies of far more essential critical care drugs, such as vasopressors, sedatives, and bronchodilators.[2] In turn, many states have sought access to Strategic National Stockpile supplies only to find that such life-saving therapies were not available or had not been included in this portfolio.[3] With the long bulge of the pandemic curve still to follow, it is likely that other commonly used drugs will face shortages in months to come.

The logistical challenges of the response to the COVID-19 pandemic recall a set of similar problems experienced as the United States responded to the anthrax bioterror attacks of September 2001. After the antibiotic ciprofloxacin was pronounced as vital to national security in the face of the acute infectious threat, the supply of this pharmaceutical agent was likewise immediately threatened by hoarding and stockpiling.[4] Although several initiatives have been developed to strengthen US public health preparedness since then, it is clear that the fundamental problem of securing a supply of pharmaceutical agents key to public health in a time of national crisis has not been resolved.