Why Medicine Shortages Happen in the UK

The Seven Root Causes

1. Manufacturing Concentration

The global pharmaceutical industry is highly concentrated. A handful of factories produce the majority of certain medicines. When one facility has problems — whether technical failures, quality issues, or regulatory shutdowns — the impact ripples across entire markets. For example, around 60-80% of all active pharmaceutical ingredients (APIs) are manufactured in China and India.

This concentration exists because pharmaceutical manufacturing has huge economies of scale. Building a new production facility costs hundreds of millions of pounds and takes 3-5 years. Few companies are willing to make that investment for low-margin generic medicines.

2. Quality Failures

Pharmaceutical manufacturing is one of the most heavily regulated industries in the world. Products must meet strict specifications for purity, potency, dissolution, and stability. When a batch fails quality testing, the entire batch must be destroyed.

Quality failures can shut down production lines for months while the root cause is investigated and corrected. The MHRA regularly inspects manufacturing facilities and can halt production if standards aren't met.

3. Commercial Decisions

Pharmaceutical companies are businesses, and they make commercial decisions about which products to manufacture and which markets to supply. The UK's pricing system (through the Voluntary Scheme for Branded Medicines and the Drug Tariff for generics) means some medicines are less profitable to sell in the UK than in other countries.

When supply is tight globally, manufacturers may prioritise higher-paying markets. This "economic unavailability" is a growing concern.

4. Demand Spikes

Supply chains are designed for steady-state demand. When demand suddenly increases — due to seasonal illness, new clinical guidelines, media coverage, or pandemic stockpiling — the system can't respond quickly enough.

Examples include the amoxicillin shortage during the Strep A outbreak and the surge in ADHD medication demand following increased diagnosis rates.

5. Regulatory Complexity

Post-Brexit, the UK has its own separate medicines regulatory system. While the MHRA has worked to minimise disruption, the additional regulatory layer means:

• Medicines approved in the EU don't automatically gain UK approval
• Manufacturers need separate UK packaging, batch testing, and quality release
• Smaller companies may not find the UK market commercially attractive enough to pursue separate approval

Read more about Brexit's impact →

6. Supply Chain Fragility

The pharmaceutical supply chain operates on a just-in-time model, similar to automotive manufacturing. Pharmacies hold minimal stock and rely on daily deliveries from wholesalers. This efficiency comes at the cost of resilience — there's very little buffer to absorb disruptions.

7. Natural Disasters and Geopolitical Events

Earthquakes in manufacturing regions, shipping route disruptions, pandemics, and trade disputes can all interrupt medicine supply. The COVID-19 pandemic was the most dramatic recent example, but smaller disruptions occur regularly.

Why It's Getting Worse

Medicine shortages have increased globally over the past decade. Contributing factors include:

• Ageing populations requiring more medicines
• Increasing complexity of treatments (biologics, personalised medicine)
• Price pressure driving manufacturers out of low-margin products
• Climate change disrupting manufacturing and logistics
• Growing demand from emerging markets increasing global competition

What's Being Done

Governments worldwide are taking action:

• Investment in domestic manufacturing capacity
• Strategic stockpiling of essential medicines
• Better surveillance and early warning systems
• International cooperation on shortage management
• Regulatory reforms to speed up approval of alternatives

How the UK government manages supply →

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