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  • Writer's pictureMitch Kossar


This is the question every clinician and every medical facility is asking of every supplier, every marketer, every wholesaler, every manufacturer, every vendor, and now every willing engineer.

In case you've ignoring the news for sanity reasons, COVID19 has created a severe global medical supply chain supply and demand mismatch. Such imbalances in recent times aren't uncommon, however we are used to massive supply deficiencies caused by natural disasters like Hurricane Maria in 2017. With COVID19 we face the opposite - a massive surge in demand for medical products our production capacity is ill equipped to handle.

Given this state of affairs, what is being done to address this demand surge and supply hospitals?

Well, we are in uncharted territory. In part, it's doing everything we can with what we already have. Production volumes can be increased, production lines switched from less needed products to higher priority ones given a little time. Take Hydroxychloroquine as an example - an old anti-malarial drug with some use in auto-immune diseases. Use in the United States was fairly sparse, and hence production capacity and volume on-hand limited. COVID19 has caused an unprecedented spike in use to the point where every wholesaler is out of stock, generics companies are restarting old production lines for it, and the Strategic National Stockpile is working to procure it. But as that ramps up, hoarding for COVID19 patients is causing supply issues for those who already needed the drug to manage auto-immune or malarial issues. Hospitals can't get even their normal supply yet, let alone enough for use to combat COVID19.

To address shortages of direct COVID19 treatments multiple other medications have already been targeted for potential COVID19 inhibition activity or associated comorbidities such as lopinavir/ritonavir (HIV medication), tocilizumab (rheumatoid arthritis), azithromycin (pneumonia), tissue plasminogen activator (clot busting!), and even zinc in combination. Every single one of these medications currently has supply problems, which negatively impacts patients. Admirably, after the panic buys in the wake of the media frenzy, Genentech has made tocilizumab (Actemra®) available to those rheumatoid arthritis patients who would otherwise be left victims of the demand.

Beyond drugs targeting the virus itself and immediate sequelae, hospitals also face enormous shortages of at least 50 other drugs necessary to weather “the peak” of this pandemic. Patients needing intense care will out number hospital capacity both in beds, but also in necessary supplied to provide care. This means much higher than normal demand of resuscitation fluids, sedatives, analgesics, paralytics, pressors, antibiotics, and respiratory medications.

Under the best of circumstances, hospitals are fighting multiple drug shortages; what we are seeing now is unprecedented.

This is to say nothing of the even more immediate need for ventilators and essential PPE like gloves, gowns, masks, face shields, goggles, plastic covers, n95 filters and similar equipment.

We in the pharma space are all working this challenge together. New roadblocks will arise, but in the end we will prevail. Let's keep working together, and sharing solutions.

Best wishes to you all,



First Principles is a boutique strategic consultancy focusing on commercial and operational strategy for pre-launch therapeutics. We are actively engaging clients in helping determine the pros and cons of repurposing their portfolios for COVID-19 and raising grant money. Please contact us at if interested.


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