News Analysis: Hurricane-induced IV fluid shortage exposes U.S. supply chain vulnerabilities

SACRAMENTO, the United States, Oct. 14 (Xinhua) -- A severe shortage of intravenous (IV) fluids affected hospitals across the United States, forcing healthcare providers to ration supplies and postpone non-emergency procedures.

This crisis, triggered by Hurricane Helene's impact on U.S. largest manufacturing facility for IV fluids, exposed long-standing vulnerabilities in the U.S. medical supply chain caused by the country's systematic failures and renewed concerns about the healthcare system's resilience in the face of natural disasters.

The current shortage began when Hurricane Helene damaged a Baxter International facility in North Carolina. This plant, which produces approximately 60 percent of the IV fluids used in the United States, suffered extensive damage and is not expected to resume production until year-end.

The U.S. Food and Drug Administration (FDA) reported that several critical IV products were already in short supply before the hurricane, exacerbating the nationwide disruption and leaving hospitals struggling to manage their diminishing stocks of these vital medicines.

The impact of the shortage is widespread.

Massachusetts General Hospital, the primary teaching hospital of Harvard Medical School, reported receiving only 40 percent of its regular supply of IV fluids. The hospital has suspended non-critical and elective procedures temporarily.

A spokesperson stated, "While we strive to minimize any impact on patients, these measures will ensure we can care for those in immediate need."

Other hospitals implemented similar measures as well. MultiCare Yakima Memorial Hospital in Washington state said it was "evaluating the situation daily and working to conserve IV fluids while still providing medical attention," according to hospital officials.

However, this crisis is not unprecedented.

In 2017, Hurricane Maria devastated Puerto Rico, where Baxter had three manufacturing sites, leading to shortages of IV bags and other medical supplies. This recurring pattern of hurricane-induced shortages highlighted the vulnerability of the medical supply chain to natural disasters, particularly when production is concentrated in vulnerable geographic areas.

The persistence of these shortages raises questions about the structural and economic factors contributing to the problem. Production concentration is a significant issue, with a single plant producing 60 percent of the nation's IV fluids. Any disruption to that facility can have far-reaching consequences.

Geographic vulnerability also plays a role, as many key production facilities are in areas prone to natural disasters, increasing the risk of supply chain disruptions during severe weather events, which are becoming more frequent and intense due to climate change.

Economic factors further complicate the situation.

IV fluids are low-cost, high-volume products with slim profit margins, discouraging manufacturers from producing alternatives or maintaining excess capacity. Additionally, hospitals' just-in-time inventory practices, driven by storage constraints and short shelf lives, leave little room for error when supply chain disruptions occur.

Government and industry's responses to these recurring shortages have varied but often offer only short-term remedies.

The FDA has approved the temporary importation of IV fluids from international manufacturers, with 12 of the 19 approved foreign-made IV products coming from China, and the rest from European and Canadian companies. Federal officials also helped move inventory away from areas threatened by subsequent hurricanes, such as Hurricane Milton.

The current IV fluid shortage is part of an ongoing drug shortage crisis in the United States dating back years.

A 2011 report in the Pharmacy and Therapeutics journal noted that drug shortages escalated rapidly, with over 240 drugs either in short supply or unavailable by 2010, and more than 400 generic medications back-ordered for five or more days.

This trend has continued to affect various critical medicines, including cancer treatments, heart drugs, pain medications, and intravenous electrolytes.

Manufacturing problems were identified as one of the leading causes of these shortages. By September 2011, 23 percent of drug shortages were attributed to manufacturing difficulties, 13 percent to supply and demand imbalances, and 55 percent to unknown causes, highlighting the complexity of the issue, according to the report.

The recurring nature of these shortages, despite past experiences, raised questions about why problems persisted. The complexity of the issue involved multiple stakeholders with potentially conflicting interests, making it challenging to align diverse groups toward a common goal.

Moreover, justifying significant investments in resilience measures during periods of normalcy was difficult, and the infrequent occurrence of major disruptions could lead to a cycle of crisis and complacency, the report's authors suggested.

These shortages create additional stress on healthcare systems already strained by challenges such as staffing shortages and financial pressures. The need to constantly adapt to supply chain disruptions diverts resources and attention from other important aspects of healthcare delivery.

As climate change increases the frequency and severity of natural disasters, the need for a more resilient medical supply chain becomes increasingly urgent.

While the current IV fluid shortage has exposed the fragility of critical supply chains, history suggests that without sustained efforts and coordinated action, the cycle of shortage and crisis will continue, leaving hospitals and patients vulnerable to future unforeseen harm.