By Christine Donaldson

By the last week of January, Canada had administered more than 75.5 million COVID vaccine doses.

It has been a gargantuan effort that, for the most part, has rolled out relatively smoothly. But what would have happened if, for example, Canada didn’t have 75.5 million syringes with which to administer the vaccine?

It’s a potential problem most people don’t think about until it is an actual problem.

The matter of procurement of healthcare supplies — from equipment to medications — has been in the spotlight since COVID arrived in Canada in early 2020. It was a hot topic in media circles and on social media. Shortly after the country essentially shut down that March, the rush to ensure we had adequate personal protective equipment in Canada was, for lack of a better word, chaos.

Then talk turned to equipment and supplies for ventilators.

Recently, the demand has been for N95 masks. Where once they were reserved for medical professionals, now everyone from teachers to grocery store managers are looking for them. This surge of demand puts incredible pressure on the medical supply chain.

All of these are procurement issues, but the area where challenges in procurement may raise the most concern is in shortages of critical medications used in hospitals and ICUs across the country.

In January, Hamilton Health Sciences revealed that it had almost no access to the COVID medication tocilizumab. Typically used in combination with the steroid dexamethasone, tocilizumab is a drug that has shown to protect the immune system and prevent the progression to severe illness in COVID patients. There are also reports of a national scarcity of the newly approved antiviral treatment Paxlovid.

The problem is there is no single root cause for a drug shortage, and not all drug shortages are the same.

Often times, they are caused by a quality issue in the manufacturing of the drug. Canada has very limited capacity for drug production, meaning we rely on imported products over which we have limited  oversight which adds complexity. We are in a global competition for supply, and it’s not a competition where we always win.

Another factor is the use of medications currently used to treat COVID that weren’t necessarily intended to treat COVID. The drug in short supply in many Ontario sites, tocilizumab, is actually a medication for rheumatoid arthritis. But studies have shown a benefit in treating COVID patients. It is difficult to plan for a surge in demand for a drug that is used off-label for more patients than normally anticipated.

And we cannot excuse the nature of the COVID virus for causing drug shortages. The evolving nature of the pandemic has created an ever-changing playing field. When the Omicron variant arrived in late 2021, it proved to spread faster than experts had predicted — even among those who were vaccinated. After Christmas a spike in both hospital admissions and patients in the ICU caused a run on medications to treat the virus.

But Canadians should be assured, that despite the pressures created by COVID and the lengthy list of drugs in shortage, there is a stable system in place that puts the patient first. This national network of pharmacy leaders discourages the hoarding of any medications in any one region, and if there is a need for a drug in a hospital that is in short supply, every effort is made to ensure that drug gets to where it is needed most.

And if there are any benefits coming from this pandemic, it’s that we have much better data on patients, where they are and what they need.

We are also building protections and redundancies into how we do business. Since the arrival of COVID, we are seeing more cooperation between organizations in the procurement of healthcare supplies. Health Canada built a federal critical drug reserve to serve as a buffer and add capacity to the system.

At HealthPRO, we have created a Critical Drug List. Every drug manufacturer we work with is required to have 90 days of critical drugs in stock and in Canada. It is a policy designed to create some runway when a surge in demand occurs, to avoid getting to a stage where there is a critical shortage.

Another good practice is to end sole sourcing suppliers. Having multiple suppliers of an essential medication boosts the bench strength and builds redundancies into the system.

Drug shortages are cause for concern, but professionals in healthcare procurement have been managing the situation for some time now. In fact, at any given time, Canada is experiencing a shortage of some 200 drugs. The Multi-Stakeholder Steering Committee on Drug Shortages has been in place for the better part of a decade monitoring the situation, and is maintaining a drug shortages website to provide more transparency on the issue.

In non-COVID times, there is little interest in the list unless you or a loved one needs one of the medications that is in short supply.

But in the midst of a pandemic, when people are worried and scared and hospitals are at capacity and patients are dying, there is spotlight shining directly on the availability of treatments.

Christine Donaldson is Vice-President, Pharmacy for HealthPRO. She leads the procurement of pharmaceuticals on behalf of more than 1,300 hospitals across Canada and is actively supporting hospitals to manage supply chain disruptions.