Dear Prime Minister,
We are writing to you today to ask you to bring attention and resources to Canada’s drug supply challenges. These shortages have existed for the past decade but have been greatly exacerbated due to the COVID-19 pandemic.
As frontline pharmacists and physicians, we have seen and heard of serious shortages of essential, critical medications. These drugs are often used simultaneously in ORs, ERs and palliative care wards, as well as ICUs. And while our ICUs are thankfully seeing fewer COVID-19 patients, the pandemic has been placing a heavy burden on their drug supply, where patients often require weeks’ worth of treatment on ventilators.
The shortages of these drugs imperil the lives of patients seeking care all over the country. Currently, the vast majority (24/32) of the drugs on Health Canada’s own Tier 3 list, which represents drugs for which there are no suitable alternatives, are essential for treating COVID-19. With the likely upcoming second wave in Canada, the potential for further exacerbation of these shortages is inevitable unless we implement rigorous preparedness measures.
At first glance, the federal government may conclude that this is a provincial and territorial area of jurisdiction. We can assure you, that there is a considerable role for the federal government to play on this issue of national concern if you so choose to take action. We believe you should.
Many of these critical care drugs should be part of the National Strategic Emergency Stockpile. However, it is clear that Canada simply did not invest enough into its stockpiles to meet the demand during the COVID-19 pandemic. In order for the stockpiling strategy to be effective, it is vital that the federal, provincial, and territorial governments work closely with hospitals, long-term care facilities, hospices and primary care facilities nationwide to establish a
comprehensive list of critical medicines and develop a plan to procure medicines
in a coordinated manner to prevent unintended competition for resources.
The 2019 budget had earmarked funds for a new Canada Drug Agency which
would have oversight over a national formulary. This proposed agency could
similarly identify essential medicines to aid in an efficient stockpiling response,
whether through stimulating domestic production or through importation and
coordination of purchasing strategies to ensure that jurisdictions that have a
greater need for medications gain access to them. We know that COVID-19’s
impact on the health system across provinces and territories and within each and
every jurisdiction was not equal or consistent.
We appreciate the active efforts of Health Canada to resolve current or projected
shortages of critical drugs through its Tier Assignment Committees. Furthermore,
Ontario has a Critical Care COVID-19 Command Centre and has created a
Critical Care Drug Shortage Task Team. Certainly, the short-term deficit will need to
be resolved through this mechanism and importing from all available suppliers.
However, to support the system at large, provincial and territorial governments will
need national support, resources and (where welcomed by provinces) a certain
level of national coordination.
Regardless of well-established Federal-Provincial-Territorial dynamics, without
concrete preventative action, Canada will perpetually face drug shortages. This is
why we recommend that your government commit to working on a long-term
solution involving a three-pronged strategy:
1. Stockpiling of a Critical Medications List which the government commits to
ensuring are always in stock for long enough to meet the needs in an emergency
(likely through the Canada Drug Agency). a. A Critical Medications List would
allow the parties involved in addressing the drug shortages to have a clear picture
of what drugs to monitor closely, and provides a more comprehensive approach
to the problem.
2. A publicly owned generic, critical drugs manufacturer, or at the bare minimum,
public support for spare capacity by Canadian-based and controlled drug
manufacturers to be used for critical drugs. a. This manufacturer or manufacturers
would specialize in manufacturing the critical drugs on the Critical Medications List,
and would be primarily involved in satisfying significant portions of our national
3. Greater transparency and communications to and from governments and
the health sector around the essential drug supply. This would include efforts to
better track the supply of drugs in hospitals across the country and push
notifications on shortages through the appropriate channels to frontline workers.
We encourage your government to give this urgent issue attention and efforts
now, so that Canadians can have the confidence that their healthcare system
will be there when they most need it.