Tornado at Pfizer Warehouse Likely to Worsen Shortage of Surgical Drugs

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A tornado that ripped apart a vast Pfizer drug warehouse in North Carolina last week will probably lead to disrupted supplies of crucial drugs used in surgery and critical care, according to estimates made by an independent nonprofit.

The tornado, which reached wind speeds of 150 miles per hour and snapped trees at the base, primarily hit a storage center where Pfizer kept raw materials, packing supplies and finished medications. The production plant at the site did not have “major damage,” the company said, noting that it’s working to restart operations soon.

Pfizer released a list of drugs that could go into shortage — or in some cases, a deeper state of shortage. They include common I.V. pain relievers like fentanyl and morphine, as well as lidocaine, used in local anesthesia, and heparin, used to treat or prevent blood clots.

Why It Matters: Some of these medicine are not widely produced.

The U.S. Pharmacopeia, a nonprofit that examines the drug supply chain, took a close look at the likely effect of the tornado damage. The nonprofit assigns “vulnerability scores” to medications, accounting for factors linked to shortages, like low prices, quality problems at production sites and the number of companies that make the drug.

The painkiller infusions had a high vulnerability score, as did I.V. electrolytes like potassium chloride and magnesium sulfate that are made at the plant and listed by Pfizer as potentially affected by the tornado. These medications help patients with severe dehydration or diabetes complications, among other conditions.

One unexpected upside to the deepening shortages of some medications is that, under federal rules, specialized pharmacies are allowed to make the drugs on an emergency basis. That policy “will come in handy at a time like this when you have an unexpected shock to the system,” said Vimala Raghavendran, a shortage expert at the U.S. Pharmacopeia.

Last Time This Happened: Cancer drug shortage threatened patient care.

This disaster struck as the last drug shortage crisis began to ease. For weeks this spring and summer, doctors were running out of two inexpensive, generic chemotherapy drugs that are the best shot at a cure for patients with testicular, ovarian and other cancers.

Doctors predicted heightened death rates as patients arrived for treatment only to discover they would not be getting the most potent drug in the combination used to treat them. The Food and Drug Administration has since begun to allow shipments of the drugs from China that were not expressly approved for the United States market.

Now, “it seems better,” Dr. Lucio Gordan, president of Florida Cancer Specialists, said in an email on Tuesday, noting that his centers have a month’s supply of the drugs, which are called cisplatin and carboplatin.

What We Don’t Know: Will Congress or the White House act?

Medication shortages are not new. But the cancer drug crisis started a widespread conversation about its root causes and solutions. Some proposals have come from Medicare, which unveiled a plan to incentivize hospitals to stockpile essential drugs. A key Senate health committee advanced a pandemic-funding bill that would give the F.D.A. more data to head off shortages.

Leaders in the generic drug industry and other experts cite the pressure from intermediary companies that award the lowest-price bidder with access to millions of customers. The “race to the bottom” in prices, they say, destabilizes the industry and rewards those who might cut corners or operate overseas, often in India, where labor costs are lowest. House Republicans have been examining some of those dynamics but have not issued proposals.