The conflict involving Iran has raised fresh concerns over medicine supply issues across the UK, with one Greater Manchester pharmacy leader warning there is a ‘real risk’ shortages could worsen if global disruption continues.
Experts warn rising prices and fragile supply chains are already putting the system under further strain, with frontline pharmacists facing growing frustration from patients at the counter.
It comes after the head of NHS England said he is ‘really worried’ about medicine supplies after the Strait of Hormuz was effectively closed at the start of the US-Israel war on Iran, pushing up energy prices and disrupting key shipping routes.
Just days ago, a two-week US-Iran ceasefire was agreed, which included a condition that ‘safe passage’ through the narrow waterway would be guaranteed. While the situation is currently considered stable – and there are no confirmed medicine shortages directly linked to the conflict – those on the ground remain uncertain over how the situation will pan out.
Luvjit Kandula, Director of Strategy and Pharmacy Transformation at Community Pharmacy Greater Manchester, told the Manchester Evening News: “Medicine shortages have been going on for a long time. We’ve been contending with sharp price increases. There’s multiple medicines that are going out of stock.
“The issue that we’ve got is that the market is very unstable. Things are going in and out of stock all the time and pharmacies are having to pay more for the medicine than the drug tariff prices that have been agreed with the NHS.
“If the conflict continues – and we’re already seeing a lot of shortages – I think there is a risk of high volume common drugs that people have going out of stock. They could start to see real shortages, but that the situation is relatively stable for the moment and being monitored closely working with our local ICB leaders.”
Why are medicines at risk?
NHS England chief executive Sir Jim Mackey warned the health service is already on alert. Speaking on LBC Radio, he said: “We are really worried about this. We’ve already had a couple of supply shocks in the last 12 to 18 months of key supplies.”
He said there is a team in place to ‘focus on where the risks might be through the supply chains’. He also said the NHS holds only limited stock.
“In every area, we’ve got enough to get through for a reasonable period… so generally, a few weeks,” he explained on March 31. “Because things perish and it costs money to store and various other things go out of use, you can’t hold years and years of supply, generally dependent on the product we keep for a reasonable period.”
The UK’s heavy reliance on imports makes it particularly vulnerable to supply disruption. Prof Liz Breen, who researches pharmaceutical supply chains at the University of Bradford, told The Guardian that 85% of medicines prescribed in the UK rely on India and China to supply.
Thorrun Govind, pharmacist in Manchester and former chair of Royal Pharmaceutical Society, says global instability affects every stage of the supply chain.
She told the M.E.N.: “The UK can be a less attractive market for manufacturers to supply to than other markets like Europe.
“When you have this general disruption to supply chains, that can impact energy, transport, raw materials – things like rising fuel and transport costs. That can be an issue.
“Some drugs have to be kept under special conditions and have got to be kept cold.”
According to Prof Breen, the medicines most likely to be affected include vaccines, insulin, specific drugs that require cold storage, and cancer therapies, due to their short shelf lives and transport challenges. Petroleum-based products such as aspirin and paracetamol are also at risk, she told The Guardian.
Ms Kandula said: “Shortages are not normal, but there is a real risk now that we could see huge shortages, price increases – it could scale up very quickly.
“There are complex factors that affect the medicine supply chain, but price affects supply, delays, and the system is under strain, and it could deteriorate very quickly if the disruption continues.”
Pressure on the frontline
For pharmacists, the impact goes beyond supply issues – and the strain of medicine shortages is increasingly visible in interactions with patients.
Ms Kandula said: “If there’s a national shortage, it then affects every single pharmacy in England. This will then have a knock-on impact on our local pharmacies here not being able to get the stock, which means there’s a delay to the patients that we serve, and a risk that patients are having to do without medication.”
She says this can lead to delayed treatment, resulting in some patients becoming ‘very upset and anxious’.
She added: “When there’s a sharp price increase for those commonly dispensed medications, suddenly you’ve got a situation where you’ve got ‘out of stocks’ coming and coming. What does that mean? Patients come in to pick up five medications but they’re only going to get three of them today, and it’s frustrating for a patient.”
Ms Kandula says pharmacists in Greater Manchester have reported incidents where patients ‘get very aggressive and abusive’. In the ‘worst case scenario,’ she says, some people can become violent.
She explained: “A few months ago…a pharmacy experienced a major security beach when a patient enraged, vandalised the pharmacy and shattered the windows. I’ve had a pharmacist who’s been hit over the head with bottles of water. There’s been criminal damage and attack on premises.”
Her warnings come as Greater Manchester health leaders have launched an anti-racism campaign, No Space for Racism, amid ‘evidence of a significant rise’ in racism and discrimination across the health and care system.
During a meeting of the Greater Manchester Integrated Care Board, Ms Kandula detailed how community pharmacy staff are being abused by ‘far more than just racism’, describing horrific attacks of physical violence.
Ms Kandula said: “We have got examples of people being strangulated, being threatened with pens, knives, pushing, punching, they’ve had threats that their premises will be burned down. I’ve had two ladies in Greater Manchester who were being filmed after 6pm because they were on their own…
“Cars are being slashed and there was one incident where a pharmacy actually had someone walk in, was mentally unstable and wasn’t getting the support they needed. And because of medicine shortages and a delay in getting their prescription to them, that then led to threatening behaviour and him going into the dispensary and smashing the shelves.
“There are wider issues than just racism – the medicine shortages, the delays, not being seen for many hours. It means that where we’ve got walk-in services, those people are taking the brunt.”
Advice to patients
Despite the warnings, pharmacists stress there is no immediate cause for alarm. Global analysts say buffer stocks should help absorb short-term disruption, with most European countries, including the UK, typically holding around eight weeks of reserves.
Ms Govind said: “Medicine shortages are not a new thing, so it’s hard to know the impact that this is going to have. We’re not seeing an immediate issue. Global conflict can be an issue and impact prices, but I wouldn’t say there was any particular issue of obtaining medication right now directly linked to this war.
“We’re not talking about ordinary items of commerce here. You’re talking about prescription medication, which you need a prescriber to write a prescription of. For patients on the ground, [advice] is just order your medication as you usually do.”
She urged patients to plan ahead and order medication with ample time before upcoming bank holidays.
She added: “I don’t think this is as dramatic as perhaps people are making it out to be right now. For a layperson on the street, what would I say to them? Keep calm, carry on.
“Don’t over-order your medication. Order your medication in time and help your healthcare team who are there to help you.”
NHS Greater Manchester said: “There is no reported medicine shortages in Greater Manchester linked directly to the conflict in the Middle East. However, medicine supply issues have increased in recent years for a range of reasons and NHS Greater Manchester has well established processes in place to monitor potential shortages and respond quickly when they arise.
“To protect patients and maintain access to treatment, we are working closely with community pharmacies GPs and partners across primary and secondary care to closely monitor the situation and manage any emerging risks. This includes strengthening day to day communication between pharmacies and GP practices and working together to identify safe and suitable alternatives where specific medicines may be temporarily unavailable.
“We would reassure patients to continue ordering repeat prescriptions as normal and not to stockpile medicines. Our priority remains ensuring patient safety and supporting continued access to the medicines people need across Greater Manchester.”
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