In April 2020, the UK had over 200 medicines on its shortage list. This elevated level mirrored the global picture. These increased shortages stemmed from the medicines being used as pain relief and sedation treatment for Covid-19 patients, yet not all were in shortage for long. For example, paracetamol saw a swift resupply within weeks of running out in the UK.
Most medicines prescribed today, including those in short supply, are imported generic pharmaceuticals. Disruptions driven by Brexit and the pandemic have meant that, despite contingency stocks, there have been shortages of critical drugs, leading to second or even third-line choices being prescribed.
Joined by a group of academics, industrialists, and NHS staff, I sought to think innovatively for a solution to this issue. The group’s proposition was a different approach to handling shortages with a new system for identifying critical treatment medicines, alongside a new way of holding safety stocks that went beyond simply storing packed stock ready for patients.
The new thinking was to hold active pharmaceutical ingredients which could be formulated into the tablets and injectables we need. Adopting such a model would reaffirm some supply chain security.
Most active pharmaceutical ingredients are produced in India and China, enabling cheaper production than is possible in the UK. However, this sole dependence on international import links leaves us precariously open to disruption. The group’s proposal addressed this but relied on having new technology which enabled production of those generic medicines at comparable costs to Indian and Chinese imports.
For the last 100 years, pharmaceutical production has largely involved batch manufacturing, which means each individual stage is isolated and stored for testing before proceeding to the next step. This creates long cycle times, typically 18-24 months.
Continuous manufacturing provides an alternative option. Similar to modern car production lines, where ingredients can be added in a linear manner with the product isolated at the end. This requires smaller factories, and production times can be reduced from months to weeks.
In Scotland, the University of Strathclyde houses the Centre for Continuous Manufacturing and Advanced Crystallisation (CMAC) which is trying to bring this process to life.
This collaboration, between seven UK universities and eight major global pharmaceutical companies, is working to develop continuous manufacturing, enabling faster, better quality medicine production with a lower carbon footprint.
The industrialisation of this new technology is taking place at the Medicines Manufacturing Innovation Centre (MMIC) shortly to open at the Advanced Manufacturing Innovation District adjacent to Glasgow Airport.
For now, the group has turned its findings over to the UK government, but as international disruptions show no signs of ceasing, the opportunities for resilient medicine supplies need serious consideration. Their adoption could not only secure our ability to supplement essential generic medicine shortages but also create jobs in a sustainable, lower carbon process.
Professor Clive Badman OBE is executive director of special projects in life sciences at Strathclyde University and a fellow of the Royal Society of Edinburgh. The RSE is Scotland's National Academy, which brings great minds together to contribute to the social, cultural and economic wellbeing of Scotland. Find out more at rse.org.uk and @RoyalSocEd