Editorial

Pressure on the global medicines supply chain is now acute. Drug shortages risk becoming a “new normal”.

The conflict in the Middle East, centred on Iran, has become the principal source of disruption in 2026, with its effects most immediately visible in transport. Key trade routes—particularly through the Strait of Hormuz—have been destabilised, affecting a corridor that carries a significant share of global pharmaceutical flows. Air freight has also been unsettled, as major logistics hubs such as Dubai and Doha face delays and forced rerouting.

• Cancer medicines and other temperature-sensitive treatments are particularly vulnerable to delays. 
• Pharmaceutical supply in Australia is already under strain, with shortages reported across a range of medicines as well as essential medical supplies such as syringes and gloves. 
• Last month, the UK was described as being on the brink of medicine shortages if disruptions continued, with existing stockpiles providing only short-term relief. 
• Pharmaceutical supply also depends on oil-derived petrochemicals used in products such as syringes, vials, blister packs and IV bags, meaning rising oil prices increase costs and add pressure to supply chains.

Logistics strain and rising uncertainty

Tomasina Dimopoulos, European Medicines Agency (EMA) representative, stated that EMA, together with the Medicine Shortages Single Point of Contact (SPOC) Working Party under the governance of the Executive Steering Group on Shortages and Safety of Medicinal Products (MSSG), is closely monitoring the impact of the war in the Middle East on medicine supply within the EU. She noted that companies are reporting varying levels of disruption, mainly linked to interruptions in air freight and maritime routes, as well as rising costs. The situation remains highly dynamic, and the risk of medicine shortages may increase if these disruptions persist.

The latest pressure is being felt most clearly through logistics. While no immediate, large-scale disruption to medicine deliveries into Europe has materialised, supply routes have become less predictable and more costly.

A significant share of global energy resources and chemical inputs essential to pharmaceutical production moves through the region. When routes are disrupted or become more expensive, the impact is reflected in longer delivery times, higher transport costs and reduced reliability. The pharmaceutical sector is not insulated from these dynamics; even gradual changes in logistics can translate into mounting pressure across supply chains.

Old shortages, deeper dependencies

The current risks build on long-standing structural weaknesses that predate recent geopolitical tensions. In recent years, shortages have affected a wide range of medicines, including antibiotics, painkillers and treatments for chronic conditions, exposing dependencies in global supply chains that remain largely unresolved.

A substantial share of active pharmaceutical ingredients (APIs) and generic medicines is produced in India and China, a concentration that has improved efficiency but also increased vulnerability; when production or exports from these regions are disrupted, shortages can quickly spread across multiple markets. These risks are now being amplified by geopolitical tensions, with disruptions to airspace, higher energy costs and increasingly complex logistics affecting both the supply of raw materials and the import of finished medicines, particularly from Asia.

At the same time, cost pressures are intensifying: transport and overall supply chain costs are rising, while pricing for many medicines—especially generics—remains tightly regulated, leaving manufacturers limited room to absorb increases and making it harder to sustain the supply of certain products over time.

Role of Critical medicines act 

Member of European Parliament Tiemo Wölken comments that Critical Medicines act pursues two main objectives. First, it aims to scale up and strengthen manufacturing capacities for critical medicinal products within the European Union. Second, it seeks to enable Member States to cooperate more effectively, including through joint public procurement of medicinal products of common interest. 

T. Wölken comments: “While the proposal is often framed as a response to medicine shortages, I would nuance that perspective. Not all medicines on the critical medicines list are currently in shortage. However, the European Medicines Agency has identified structural vulnerabilities in supply chains that could lead to future shortages. Addressing these vulnerabilities is therefore a key priority. It is also important to distinguish between different categories of medicines. 

Critical medicinal products are those where supply risks stem from dependencies and fragile supply chains. By contrast, medicines of common interest may not be in shortage due to supply constraints, but rather due to strategic or commercial decisions by pharmaceutical companies. These are fundamentally different challenges and require different policy responses.

From my perspective, it is important to concentrate on critical medicinal products when it comes to strategic projects, as these are the areas where vulnerabilities and dependencies have already been identified by the European Medicines Agency. Given that the Critical Medicines Act is designed to support the scaling up of manufacturing and to strengthen supply resilience and considering the limited resources available, it is essential to prioritise efforts where they are most needed. In addition, projects that have been identified as strategic can benefit from regulatory fast-tracking, expedited permitting procedures, and administrative as well as scientific support from the relevant national authorities.

Furthermore, our efforts should focus on reducing dependencies for critical medicines, while at the same time giving Member States the tools to jointly procure medicines of common interest where necessary. In addition, we should strengthen cooperation between Member States on shortage prevention. This includes improved transparency, coordination, and responsible management of stockpiles. It is essential to ensure that stockpiling in one Member State does not negatively affect access in another. This requires a high level of coordination and cooperation, elements that are reflected in the Parliament’s mandate.

Finally, when discussing access to medicines more broadly, shortages are only part of the picture. A significant challenge lies in the differences between national pricing and reimbursement systems. Some Member States provide rapid access to innovative treatments, while others face delays. Ideally, patients across the European Union should have equal and timely access to medicines, regardless of where they live. However, the current EU Treaties limit the extent to which such systems can be harmonised at European level.”

Evolving role of pharmacies

Pharmacies play a key role in medicine shortages linked to disruptions, as they are often the final point where supply gaps are managed, alternatives are provided, and treatment continuity is maintained for patients.

Mgr. Irena Storová from European Federation of Pharmacy chains comments: 

“Pharmacies are one of the most accessible contact points between citizens and the healthcare system — often the first and most frequently visited. At EFPC, we firmly believe that their role in prevention is not only evolving — it is essential, and we have long awaited full recognition at the political level.”
She notes that pharmacists in all member organizations are increasingly engaging as active contributors to preventive care — from health screenings and chronic disease monitoring to vaccination and patient counselling. “We strive to inspire each other and provide maximum support. This is exactly the shift we need to see across the EU: from pharmacists as medicine dispensers to pharmacists as integral members of interprofessional primary care teams.

For this transition to be successful, however, it must be supported by clear policy frameworks, followed by adequate reimbursement for preventive services, investments in digital tools such as integration with electronic health records, and stronger collaboration with doctors, nurses, and public health authorities. EFPC calls on EU member states and the European Commission to meaningfully integrate pharmacies into national and European prevention strategies.”

She also accentuates the importance of strengthening local pharmaceutical manufacturing in the EU: “The COVID-19 pandemic was a warning that Europe cannot afford to ignore. Excessive dependence on distant supply chains for critical medicines revealed serious vulnerabilities in our healthcare systems — vulnerabilities that directly affect patients’ access to treatment.

Strengthening local and regional pharmaceutical manufacturing in the EU is not merely a matter of industrial policy — it is a public health imperative.

Strategic independence in drug manufacturing means resilience in times of crisis, fairness in access across all member states, and the ability to respond quickly to emerging health threats. Smaller and economically weaker EU countries are disproportionately affected when supply chains fail, and this is simply unacceptable in a Union built on solidarity.”

EFPC strongly supports EU-level investments in local manufacturing capacity, transparent monitoring of medicine supplies, and policies that promote the production of essential medicines closer to home. “A healthy Europe needs not only strong primary care — it needs safe and sovereign medicine supplies,” she concludes.

14.04.2026.