Strengthening what we already have: collaborations to prevent medication shortages amid COVID-19.

In recent months we have all experienced the many challenges presented by the COVID‐19 pandemic. It was only at the end of 2019 that this novel coronavirus emerged, and for most of us the potential implications didn’t hit home until February this year or even later. Since this time, we have had to make many decisions, both professionally and personally. We have had to balance the many risks associated with COVID‐19 against the benefits of activities and services that could increase exposure and the consequences of infection. This has been challenging, especially as the evidence to guide such decision‐making has been rapidly evolving. The haste to provide evidence to support practice has created additional challenges, with the rigor of analysis sometimes being compromised – the case of hydroxychloroquine is a very recent example. Ultimately, the pandemic has required us to be more open in our thinking. We have needed to harness the creativity that exists to identify the many problems ahead, and the solutions to these problems.

Globally there has been, and continues to be, massive demands on health system capacity, resulting in rationing of resources as demand has outstripped supply. There have been significant efforts to increase capacity, with immediate recognition of the lack of ventilators and personal protective equipment (PPE).

Medication shortages were becoming apparent in countries with large numbers of COVID‐19 patients. These shortages were a result of both ‘required demand’, that is for specific use to provide care, and for ‘perceived demand’, such as community stockpiling. In Australia, the early attention was on shortages within the ambulatory sector associated with potential stockpiling by concerned individuals, a phenomenon experienced elsewhere.

However, the major risk was the potential for shortages of critical medications for ventilated patients. This was soon recognised by clinicians, especially those within critical care and pharmacy, and within the pharmaceutical supply chain. Concerns regarding shortages of intravenous opioid analgesics, sedatives and neuromuscular blocking agents (NMB) were raised from February onwards and reflected experiences in countries with significant cases of COVID‐19. The challenges faced locally and nationally in addressing the potential shortages of these critical medicines were significant. The clinical course of the disease was largely unknown and the evidence to guide practice was scant. Modelling was performed that projected potential requirements for intensive care admissions and capacity. , Health services everywhere were tasked with preparing for a massive influx of patients requiring ventilation. This required a parallel increase in the availability of these essential medications. Clinician preferences for NMB and sedation wasn’t known. The dosages and duration required were unknown. The potential availability of these medications from the pharmaceutical supply chain was also unknown.

What we did know was that we needed to act and act quickly. As always in a time of crisis, the existing foundations either provide strength to build upon, or weaknesses that soon become evident. During the last few months the collaborations that already existed within and beyond our health services, within and beyond our healthcare professions, and within and beyond our borders have been a foundation enabling so much to be achieved in a short time. There are numerous examples from this effort that we could all share, and I will illustrate this with just a few.

Intensivists, anaesthetists and ICU pharmacists worked together to identify the national preferences for medications for ventilated patients. A national survey of clinicans was developed, undertaken and completed within only two weeks. The results were instrumental in informing strategies and priorities to address medication availability for these patients.

Multiple professional organisations – including the Society of Hospital Pharmacists of Australia (SHPA), the Australian and New Zealand Intensive Care Society (ANZICS), and the Australian and New Zealand College of Anaesthetists (ANZCA) – worked to provide input and evidence to inform decisions regarding availability of these medications. Consensus guidelines for the clinical care of patients were developed through the National COVID‐19 Clinical Evidence Taskforce that also built upon existing expertise and collaborations.

The availability of these critical medications was tracked through weekly hospital pharmacy snapshot surveys conducted by SHPA. The Commonwealth Department of Health, through the Medicine Shortages Taskforce of the Therapeutic Goods Administration, facilitated engagement with the key supply chain stakeholders, including Medicines Australia, the National Pharmaceutical Services Association (NPSA) and the Generic and Biosimilar Medicines Association (GBMA) amongst others. Data on medication availability was made available by the pharmaceutical companies. Data on usage in private hospitals was made available from private hospital providers. All our States and Territories were instrumental in providing medication usage data on all ventilated COVID‐19 patients. This facilitated the development of a national demand model for these critical medications – pivotal to informing efforts to facilitate access to these medicines.

This work is only one example of many in which the existing collaborations, expertise and dedication – of and between both individuals and institutions across this country – has made an impact on the response to the pandemic.

There are no doubt many things we could be doing better. There are more lessons still to be learnt, as there always is. , As we continue to work together through this pandemic, we will continue to benefit from the collaborations that we all have – and which we have strengthened – during this time.

Conflicts of interest statement

The author declares that he has no conflicts of interest.