The amoxicillin shortages are not caused by supply problems, but rather demand exceeding forecasts.
An op-ed from Senator Marco Rubio (R., Fla.) says, “Amoxicillin Shortage Shows the Need for Domestic Drug Production.”
It does not, in fact, show that.
There have been some shortages of amoxicillin this fall due to a surge in prescriptions for antibiotics. According to the Washington Post article that the press release cites, “The shortage isn’t at a crisis level and may be short-term, lasting as long as the season of illness does. . . . Still, for now, some may run into snags getting their prescriptions filled.”
That’s a problem, but the relevant question to evaluate Rubio’s proposal is: Would more domestic production make it less of a problem?
We know from the experience of the baby-formula shortage that domestic production does not ensure stable supply. Nearly all baby formula sold in the United States is produced in the United States, and that shortage was far more widespread than this one for amoxicillin is.
The four largest companies that supply amoxicillin to the U.S. are based in India, the U.K., Switzerland, and Israel.
Part of the advantage of global supply networks is multiplicity of suppliers to fill gaps when one supplier has a problem. That was what made the baby-formula shortage such a pressing issue: There weren’t sufficient backups for Abbott Labs when it ran into production problems. The shelves just went unfilled.
Regardless, the amoxicillin shortages are not caused by supply problems, but rather demand exceeding forecasts. There wasn’t a natural disaster or a factory that closed or a ship that sank. The problem, as the Post reported, is “an intense surge in RSV” among kids “whose immune systems had little exposure to RSV during the first two years of the pandemic.” The story continues:
Though amoxicillin does not treat respiratory syncytial virus, or RSV — nor does it work for flu or covid — it is frequently prescribed for bacterial infections. Kids with RSV or the flu can develop symptoms that are hard to distinguish from bacterial infections or can contract a bacterial illness secondarily, experts said, sometimes leading doctors to prescribe amoxicillin just in case.
“That’s why we really are having a run on amoxicillin,” said Tina Tan, a pediatrics professor at Northwestern University’s medical school and a doctor at Lurie Children’s Hospital of Chicago. “Because the viral illness can cause other conditions that look like they might be bacterial, people are putting kids on amoxicillin.”
Those kinds of forecasting misses happen. They’re probably more likely to happen now given that the ordinary cycle of seasonal illnesses was disrupted by Covid policies. This seems to have been yet another foreseeable consequence of school closures that policy-makers either ignored or failed to consider.
Rubio’s op-ed says, “Far-flung supply chains, still backed up from the initial shock of COVID-19, have been unable to compensate for the surge in demand.” The implication of Rubio’s argument, though, is that giving the federal government more power to direct the supply chains for drugs through financial incentives and restricting them at water’s edge would better compensate for the surge in demand. What superior powers of foresight government would have to better project amoxicillin demand is left unsaid.
Part of the problem of excessive demand for antibiotics is that doctors in the U.S. prescribe them too often for illnesses that do not really require them. That leaves less antibiotics at any given point in time for people who truly require them. Overprescription of antibiotics also causes negative health consequences by leading to drug-resistant strains of bacteria and forcing people to move up to stronger antibiotics when they truly need them. That’s a problem that health experts have known about for years, and it has nothing to do with supply.
Rubio provides no evidence in his op-ed that the present shortages in amoxicillin would be ameliorated by domestic production. What we know about domestic production from the baby-formula shortage indicates it could make things worse. Either way, the causes of the current shortages are demand-side, and Rubio’s supply-chain proposal is not germane.