[There is an ongoing problem of drug shortages. ]
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PUBLIC PHARMA IS THE BEST SOLUTION  
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Dana Brown and Christopher Morten
August 9, 2023
Stat
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_ There is an ongoing problem of drug shortages. _

, Adobe

 

Drug shortages in the United States are at a record high
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At least 14 essential generic cancer drugs
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are currently in shortage, forcing patients and doctors to make
difficult decisions to delay or ration first-line treatments, or
accept second-best treatments
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ADHD treatments
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antibiotics
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children’s acetaminophen
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and many other critical medicines are also in short supply.

But most of the solutions being discussed are just Band-Aids on a
broken system. They would do nothing to transform the incentives that
routinely produce shortages and other market failures.

What we really need — for the health of our economy and society —
is a robust public option in pharmaceuticals
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distributes essential medicines, such as cancer treatments. Publicly
accountable public agencies can assure resilient supply chains and
offer medicines at or even below cost, because keeping people healthy
without bankrupting them in the process is good for society (and
cost-effective to boot). This already happens at scales large and
small all over the world, including Brazil
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the U.K.
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India
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Thailand [[link removed]], and more.

The White House
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prominent members of Congress
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the Food and Drug Administration
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patient groups, leading academics
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and the generic pharmaceutical industry itself
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all agree that U.S. drug shortages have become a crisis. The market is
failing to provide many of the medicines we need most. The stark truth
is that for-profit drug companies have increasingly little interest in
making the low-priced, generic medicines that account for 90% of all
prescriptions. The majority of generic drugs are now supplied by just
one or two companies [[link removed]]. Rather than
make the cheap medicines that work best for many patients, companies
prefer instead to reap much greater profits from newer, higher-priced
products.

We agree with the generic pharmaceutical lobby
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and other experts
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that America urgently needs major public investment in new
infrastructure to make and distribute essential generic medicines. But
we think it is shortsighted to assert that this public investment
should come in the form of further subsidies
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to the same companies that have created dire shortages time and again,
stretching back to the 2000s
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Given recurring shortages — and the broader context that Americans
pay the world’s highest drug prices
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a movement for public pharma is picking up steam. States from Michigan
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to Maine
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are exploring getting back into the business of making medicines. The
most prominent is California, which has committed tens of millions of
dollars
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to making low-cost, off-patent versions of insulin and naloxone.
California Gov. Gavin Newsom said in 2022
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that “[n]othing epitomizes market failure more than the cost of
insulin” and that “California is now taking matters into its own
hands.” The first CalRx insulins are expected to be available on the
market in 2024
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“Socialized” pharma may sound radical, but it is not. In fact,
there is a long, successful, and ongoing track record
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of government-owned drug manufacturing right here in the United
States. For example, for more than 125 years
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Massachusetts state-owned MassBiologics has made and distributed
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plasma derivatives, and (more recently) monoclonal antibodies. The
Walter Reed Pilot Bioproduction Facility
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produces vaccines and other biologics as part of the Defense
Department’s research and development efforts. In the 1980s and
’90s, the California Department of Public Health created, from
scratch, a successful nonprofit treatment for infant botulism
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and California continues to
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product today.

In the past, public production was even more widespread in the U.S.
The state-owned Michigan Biologic Products Institute successfully
manufactured anthrax and rabies vaccines
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for decades until its privatization in 1998. The New York State Public
Health Department developed and manufactured
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early 1900s. In the 20th century, as prevailing economic orthodoxies
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these and other state-owned laboratories were shut down or sold to
private owners. (The same trend toward privatization claimed
Canada’s famed publicly owned Connaught Laboratories
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1920s, Connaught Laboratories became the first institution in the
world to manufacture and distribute insulin, and it sold insulin and
other products on a nonprofit basis
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decades.)

Reviving public manufacturing of essential medicines in the U.S.
won’t be easy and won’t happen overnight. Big pharma wields
incredible political power in Washington, and its lobby will
undoubtedly fight
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any proposal seen as an incursion into “its” markets. Moreover,
creating new manufacturing and distribution capacity requires
significant, multiyear upfront investments that public officials are
often hesitant to make.

However, the case for new investments in public pharma grows stronger
with each new shortage, each public health emergency, and each
medicine priced beyond the reach of ordinary Americans. Currently
pending proposals prioritize manufacturing of generic drugs for which
there have been recurring shortages (such as naloxone
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and antibiotics), as well as drugs with chronically high prices and
pronounced equity implications (such as insulin
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and asthma inhalers).

Now is the time for Washington to get on board, as was most recently
suggested
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by Sen. Elizabeth Warren (D-Mass.) and Rep. Jan. Schakowsky (D-Ill.).
The federal government has unique advantages when it comes to making
medicines — advantages of scale, of distribution, of legal
authorities to authorize use of privately owned patents when needed
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order domestic companies to make
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vital drugs for “national public health.”

Building publicly owned drug manufacturing facilities would dovetail
with President Biden’s avowed commitment to a vigorous new
“industrial policy”
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that brings manufacturing back to the United States. Public pharma
would yield stable, high-paying jobs for domestic scientists,
engineers, line workers, and others who have faced stagnating salaries
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and layoffs
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as the pharma and biotech industries become ever more financialized,
consolidated, and outsourced
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Drug shortages are a man-made catastrophe. Our current system has
caused them, by making essential health care reliant on a handful of
for-profit drug companies. Rather than double down on a broken system,
now is the time to embrace a robust public option in pharma. Doing so
will not only address critical shortages but begin to rebalance power
between Big Pharma and the people, bringing other long-awaited reforms
closer to reality.

_Dana Brown is the director of health and economy at the Democracy
Collaborative, where her research focuses on health and care systems,
the pharmaceutical sector, and economic transformation for health and
well-being. Christopher J. Morten is an associate clinical professor
of law at Columbia Law School and director of Columbia’s __Science,
Health & Information Clinic_
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He is an expert on pharmaceutical and intellectual property law._

[STAT] [[link removed]]

Reporting from the frontiers of health and medicine

* drug shortages
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* pharmaceutical companies
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* public ownership
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