No Shortage of Solutions

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This story is from the 2025 issue of Discoveries, a UC San Diego Health Sciences magazine.

Imagine a patient rushed to the hospital during a heart attack. While performing CPR, the emergency medical team reaches for a ready-to-use epinephrine pen to restart the heart. But due to a shortage of the lifesaving pens, the provider has to grab a vial of epinephrine instead, remove the cap, swab it with alcohol and draw the medication out with a syringe before injecting it, wasting valuable seconds that could make a difference in the outcome.

The problem extends far beyond epinephrine. On any given day, more than 200 medications from all drug classes are in short supply in the U.S., according to the American Society of Health-System Pharmacists. These include everything from simple antibiotics such as amoxicillin for children’s ear infections to the life-saving chemotherapy drug vinblastine, which, in combination with other therapies, can cure Hodgkin’s lymphoma.

“Shortages of critical medicines have increased tremendously in the last several years — it’s a global crisis,” said Brookie Best, PharmD, dean of the Skaggs School of Pharmacy and Pharmaceutical Sciences at UC San Diego. “Drug shortages can damage the health of patients and force clinicians to make gut-wrenching decisions.”

In response to the drug shortage crisis, pharmacists throughout UC San Diego Health are working tirelessly to head off shortages by making strategic drug purchases and by formulating alternatives to take care of patients, says Best. Spearheading this effort is Charles E. Daniels., PhD, chief pharmacy officer at UC San Diego Health and a clinical professor at the Skaggs School of Pharmacy.

Daniels says the shortage of brand name drugs like glucagon-like peptide-1 (GLP-1) medications to treat diabetes and obesity have made the news recently. But the majority of drugs in short supply in the U.S. are actually generics, including sterile saline, a hospital staple used to keep people hydrated.

Also in short supply over the past decade have been the key components of parenteral nutrition, given via IV to premature infants.

“Having to give less than what they need may affect these babies for the rest of their lives, not to mention drastically increasing their costs of health care over their lifetime,” said Best.

According to Daniels, one reason for the shortages is that after drugs come off patent, the manufacturing of generic ingredients frequently shifts overseas, which adds complexity to the supply chain. Natural disasters can also destabilize supplies. For example, in fall 2024, Hurricane Helene pummeled the Eastern Seaboard, disabling a major supplier of IV fluids in the U.S. This caused hospitals to conserve supplies and at times delay procedures.

Shaping Policy

In addition to strategically preparing for shortages, UC San Diego has emerged as an international leader in shaping policy to build a more resilient drug supply chain.

“Insufficient financial incentives are the root cause of many drug shortages,” according to Inmaculada Hernandez, PhD, professor of clinical pharmacy at the Skaggs School of Pharmacy. “Some drugs create so little profit that manufacturers do not have enough incentive to produce them.” When this happens, the supply chain suffers, endangering public health.

In December 2023, Hernandez testified before the U.S. Senate Finance Committee that the generic drug reimbursement model needs reform because it currently does not provide financial incentives for manufacturers to invest in resilient supply chains. Hernandez also recommended that the government rebuild the generic drug manufacturing infrastructure in the U.S.

In addition, Daniels has urged Congress to create incentives to support nonprofit drug manufacturers and to create a strategic reserve of generic drugs.

An International Priority

In 2024, the White House called upon UC San Diego to host the inaugural summit of the Bio-5 Coalition on drug shortages. Global pharmaceutical industry leaders and government representatives gathered to address the growing crisis.

Summit attendees also toured a laboratory at Jacobs School of Engineering that is trailblazing efforts to bioengineer microorganisms that produce the raw materials for hard-to-find drugs and another laboratory that creates 3D bioprinted tissues that can be used to test new drugs.

Local Manufacturing

Another way to shore up the supply chain is to manufacture the drugs closer to home. According to a recent report by the Institute of the Americas, a think tank located on the UC San Diego campus, Southern California’s life sciences and pharmaceutical prowess, combined with Baja California’s robust manufacturing base and a strong binational relationship make the region ideally situated to produce generic drugs.

“The drug supply chain is incredibly complex,” said Best. “With contributions from experts across disciplines, including policy reform, better predictive models, nimbler mitigation strategies, manufacturing innovations and collaboration across stakeholders, UC San Diego is tackling the drug shortage crisis head on."