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As President Trump’s conflict with Iran continues, it is increasingly threatening the pharmaceutical supply chain, potentially driving up the costs of numerous medications, especially those reliant on petrochemical components.
The ongoing turmoil in Iran and the effective blockade of the Strait of Hormuz have led to a surge in energy costs and created disruptions across various industries’ supply chains. Although the Middle East is not a pharmaceutical manufacturing giant like China or India, it still contributes certain products, and many medications depend on petrochemical ingredients.
“Prolonged instability could lead to longer lead times and higher transportation costs, which would impact the essential materials needed for our medicines, including the critical starting components for active pharmaceutical ingredients,” explained Gerren McHam, Vice President of External Affairs at the API Innovation Center, in a statement to The Hill.
The U.S. Pharmacopeia (USP) has released a risk assessment report regarding the conflict in the Middle East, indicating that the current impact remains minimal. The region accounts for just 0.3% of active pharmaceutical ingredient (API) production and 0.6% of oral solid dose production, primarily based in Jordan and Israel.
Nevertheless, there are specific medications where these two nations play a major role. Jordan is responsible for producing about half of the world’s supply of amoxicillin oral suspension and the same proportion of etomidate’s API, a rapidly acting anesthetic. Additionally, Israel and Jordan collectively produce 73% of the API for flumazenil, a drug used to counteract benzodiazepine effects.
Health care experts say there are alternative treatments for all these medications, and providers are well prepared to work around any potential shortages.
“There are therapeutic alternatives. We’ve actually weathered some drug shortages of those products in the recent past anyway, so we are familiar with some mitigation strategies if needed,” Michael Ganio, senior director of pharmacy practice and quality for the American Society of Health-System Pharmacists, told The Hill.
Ganio noted that Israel is also the sole supplier of some drugs but added that these are “niche orphan drugs” and opined that the impact would still be limited if the conflict affected these medications.
Pharmaceutical production aside, the Strait of Hormuz is a critical trade route, and that has observers more concerned, especially if the conflict drags on for much longer.
“Much larger impact is disruption of airspace and waterway trade routes — tough to quantify but we know a high volume of ingredients from India need to go west to Europe for final manufacturing. Logically that supply chain is vulnerable,” the USP noted.
The organization highlighted the Red Sea, separated from the Strait of Hormuz on the western coast of Saudi Arabia, as being a much higher source of risk, as it sits along the same trade route that India uses to the transport large volumes of API and finished doses to the U.S. and Europe.
Houthi rebels in Yemen on Friday threatened to enter the war to support Iran. The group could likely shut down the Bab el-Mandeb Strait on the Red Sea, much as Iran has done with the Strait of Hormuz, throttling another key shipping corridor.
India is a major global producer of generic drugs, which make up the vast majority of prescriptions in the U.S. With margins for these medications already paper thin, the added pressure of higher energy costs and a more treacherous trade route could price producers out of the market.
Ganio called this potential pressure on generic drug imports “almost an indirect tariff.”
Petrochemicals, derived from oil, are a key starting material for most medications. If heightened energy prices continue far into the future, those cost increases are likely to be passed on to consumers.
A 2011 analysis of the pharmaceutical industry’s reliance on petroleum estimated that 99 percent of pharmaceutical feedstocks and reagents are derived from petrochemicals, and there are relatively few substitutes for these materials.
As of Friday, the cost of crude oil has risen above $100 a barrel, with projections that it could go far higher if the war continues for weeks or months.
Petrochemicals aren’t directly going into the composition of drugs, but they are needed for production.
“Things that aren’t directly in the medications, but they’re needed in the chemical synthesis pathways,” Ganio said. “So, there may be some drugs that are based on a petrochemical, smaller hydrocarbons potentially.”
And as with almost all products, these chemicals need to be shipped around the world. Still, those familiar with the pharmaceutical supply chain aren’t alarmed yet.
“At the moment, in terms of the U.S., there’s no indication that the conflict is having anything directly impacting the supply chain, or availability of medicines,” McHam said.
“This is a reminder of how exposed we are with our pharmaceutical supply chain, specifically generics; especially those key materials that go into those medicines,” McHam added. “Because the real risk may not be today, but it raises a broader kind of bipartisan concern. The next event of disruption, if it’s more concentrated or is a critical part of our supply chain, what will happen?”