The COVID-19 pandemic has resulted in shortages of tocilizumab, a drug used to treat the disease in patients admitted to hospital, owing to high demand and limited supply. The authors of an Analysis article in CMAJ (Canadian Medical Association Journal) propose a 3-stage framework to help manage this shortage and potential future shortages.

“Health systems can rapidly respond to shortages of essential medications by estimating the clinical demand, assessing drug supply and potential inequities in access, and enacting policies grounded in an ethical framework for drug allocation,” writes Dr. Amol Verma, St. Michael’s Hospital, Unity Health Toronto, and the University of Toronto, with coauthors.

Tocilizumab, an anti-inflammatory medication used to treat rheumatoid arthritis or immune responses in people undergoing some types of cancer therapy, was discovered to be effective in treating people in hospital with severe COVID-19. It is manufactured by only one company and is in high demand worldwide. It is one of only two therapies demonstrated to save lives in patients with severe COVID-19.

The authors estimate that for every 1,000 adults hospitalized with COVID-19, more than 400 would be eligible for treatment with tocilizumab, which could potentially prevent 17 people from dying and 12 people from being ventilated.

To distribute resources during the pandemic, they propose a 3-stage approach based on 7 guiding ethical principles (beneficence, equity, reciprocity, solidarity, stewardship, trust, and utility):

• Stage 1 – treat as many people as possible by conserving and sharing drug supply and increasing procurement and/or access.
• Stage 2 – direct supply to people most likely to benefit based on current evidence.
• Stage 3 – If Stage 1 and 2 efforts cannot meet demand, Stage 3 involves using a fair procedure to choose between patients, such as a lottery system, to ensure that distribution of scarce resources does not worsen existing inequities.

The authors state that “tocilizumab is in short supply and demand for the drug may increase. There is a risk of suboptimal and inequitable distribution of this scarce resource if a dedicated system-wide procurement and allocation effort is not made. The 3 stages described above could be put into operation within health systems to manage tocilizumab supply.”

They conclude that “lessons from responding to this drug shortage can inform other unexpected disruptions in drug supply and future pandemic preparedness.”

“Managing drug shortages during a pandemic: tocilizumab and COVID-19” was published May 5, 2021.