Protecting existing patients in the next rush to buy up a promising Covid-19 treatment may require a national database of drug supplies and more reporting requirements to stave off hoarding.
The fractured federal response to the pandemic has pitted facilities against each other for medicines and supplies, say supply chain specialists, doctors and policy analysts. When new research promotes a drug as a treatment for the virus, orders for it skyrocket, according to Soumi Saha, director of advocacy at Premier Inc., a policy and research group that connects over 4,000 hospitals across the country.
Hydroxychloroquine prescriptions spiked 135% during March after President Donald Trump promoted it as a “promising” Covid-19 treatment, making it difficult for people who depend on it to treat arthritis or lupus to get it. There are already shortages of IV versions of dexamethasone, used to treat cancer, severe allergies, and intestinal issues among other ailments, after early research showed some benefits for Covid-19 patients with late-stage symptoms.
Panic buying for promising virus treatments will continue if hospitals, doctors, and patients aren’t confident they’ll be able to get medications when they need them, Saha said.
“You need a cohesive national approach,” Saha said. “Absent that, you’ll continue down this fragmented approach. And lessons learned in the last six months is that this fragmented approach doesn’t work.”
Creating a policy to rein in fear—the underlying cause of drug hoarding—is difficult, policy analysts admit. There is no guarantee for people who take a certain drug that they’ll always have access to it. But giving hospitals and individuals enough information to create contingency plans will help mitigate some of the damage hoarding and shortages cause, they said.
Demands for a Central Database
The first wave of pandemic legislation, passed in March, required drugmakers to give the Food and Drug Administration more information about anticipated drug shortages, like how long a drugmaker anticipated the shortage would last. The law also broadened the types of drugs that would require reporting to include any drug that’s crucial during the Covid-19 pandemic.
But the law didn’t go far enough, supply analysts say. Federal officials and hospitals still don’t know where the majority of the products are made, which makes it harder to anticipate shortages. Hospitals in different areas of the country also don’t communicate with one another about what they have squirreled away.
A centralized database that requires reporting for local hospitals would help fill in information gaps at a local level and help health officials funnel drugs to areas where they’re desperately needed, Saha said.
Federal lawmakers are also trying to promote transparency around the National Stockpile, a repository of emergency medical supplies. The latest funding measure for the Health and Human Services Department includes requirements for weekly reports to lawmakers from HHS about emergency equipment in the stockpile and how it’s distributed until the Covid-19 public health emergency declaration lifts. So far Congress has struggled to get details about supplies.
Until then, prescribing recommendations could help doctors decide when they should give someone a drug that’s in short supply, according to health services researcher Stacie Dusetzina. Those recommendations would have to be hyper-localized because only the local hospital will know enough about their supplies to give their doctors a contingency plan.
“These things are really challenging, but the more we have people clearly communicating, the better,” Dusetzina said. So far “we’ve had a real clear lack of messaging.” That’s put additional weight on health providers’ shoulders because they have to act as healers and as medical messengers, she said.
Science at the Speed of Light
Science typically moves slowly. Experiments are time and labor intensive, and scientists have to jump through several hoops before they can get research published. That process is moving quickly now because there’s an unprecedented hunger for information about how the coronavirus works and what treatments are effective.
It makes planning and communicating best practices difficult because research is continuously shifting clinicians’ understanding of how to best treat their infected patients, said Vinay Prasad, a doctor and professor of medicine at the University of California San Francisco, said.
“What coronavirus has done in just 6 months’ time is give a wake-up call for everyone that practices medicine,” Prasad said. “You can’t take your eye off this field because it’s changing at the hour by hour pace. If you’re not reading the news, or good journals with summaries, or even social media websites for a week you’ll be really behind.”
In some instances, individual patients are hoarding drugs because they don’t understand when it’s safe or effective to use them, he said.
That’s what happened with hydroxychloroquine.
After Trump touted it, pharmacists reported getting fraudulent prescriptions from people hoping to use it to protect themselves from getting the virus—a notion not backed by any evidence. Some states eventually passed emergency laws regulating when pharmacists could fill hydroxychloroquine prescriptions.
Eventually the Food and Drug Administration warned against using it for Covid-19 because it had dangerous side effects. The agency withdrew authorization for the drug to be used on hospitalized patients outside of clinical trials.
“That’s a challenge of messaging,” Prasad said. “The right medicine to the right person at the right time can be medicine. But that same pill to the wrong person at the wrong time can be a poison.”
Providers worry something similar might happen with dexamethasone. It’s typically taken in hospital settings, which makes it harder for patients outside the hospital to access, but there are oral versions of the drug too.
The IV version of the drug has been in shortage since mid-June. Recently, the FDA relaxed certain production regulations to make the drug more accessible for hospitals struggling to buy it from their regular suppliers. Now hospitals can create contingency plans for dexamethasone, but concerns about future shortages of other potential virus treatments still haunt supply chain specialists everywhere.
“The hoarding and boom and bust cycles are pure human nature, so are inevitable,” said immunologist Gigi Gronvall, a health security researcher and professor at the Johns Hopkins Bloomberg School of Public Health. “But planning to minimize those impulses and mitigate their impact seems like an important thing to do to avoid or minimize them.”
—With assistance from Christina Brady