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Media And Political Bulletin – 19 March 2020

Media and Political Bulletin

19 March 2020

Media Summary

Will coronavirus lead to drug shortages for the NHS?

The Guardian, Andrew Hill, 19 March 2020

The Guardian reports that the coronavirus pandemic has increased the risk of shortages of several essential medicines. Raw materials for many key drugs, such as antibiotics and statins, are manufactured in China, and then exported to India and other countries where they are formulated into tablets or injections, for sale worldwide.

Indian companies procure 70% of their raw materials with ingredients from China, and the NHS imports 80-90% of its drugs supply from abroad, and 25% of its generic drugs from India.

At the height of the Chinese Covid-19 epidemic, Chinese factory production was stopped. Workers were quarantined and transport between factories was disrupted. In response to shortages, India banned exports of key medicines such as antibiotics, statins and paracetamol.

In the short-term, as a result of no-deal Brexit planning, the NHS has a reserve supply of drugs to prevent shortages occurring. But these contingency plans won’t last forever. Andrew Hill, senior research fellow in the Institute of Translational Medicine at the University of Liverpool, explores whether this will mean shortages for the NHS.

NHS England: Pharmacy income protected during COVID-19 pandemic

C+D, Valeria Fiore, 18 March 2020

C+D reports that as the UK prepares for the “peak” of the COVID-19 outbreak, English community pharmacies’ income will be protected if dealing with the virus means that “routine contracted work has to be substituted”, NHS England CEO Simon Stevens and NHS chief operating officer Amanda Pritchard said in a letter to healthcare professionals on March 17.

Specific guidance on this will be issued in due course, along with advice on how to claim for additional funding to cover the costs of responding to the outbreak.

Royal Pharmaceutical Society (RPS) English Pharmacy Board chair Claire Anderson welcomed NHS England’s “flexible approach”, noting that it would “come as a relief to many”.

COVID-19: NI pharmacists to halt industrial action to deal with crisis

C+D, Nora Elias, 18 March 2020

C+D reports that Community Pharmacy Northern Ireland (CPNI) has announced that planned industrial action, which its members voted in favour of last month, has been put on hold as a result of the pandemic. A spokesperson for the representative body told C+D that the measure has been postponed “for the foreseeable as community pharmacy plays an integral role in getting everyone through coronavirus”.

Some pharmacies in the country are currently dispensing around four times as much medication in a week as they normally would, the CPNI added.

The representative body urged the public to show understanding of the mounting pressure pharmacies are under due to COVID-19 and to “work with the new arrangements pharmacies are having to introduce in order to deal with the surge in patient and prescription requests”.

NICE finds new chief to replace retiring founder

HSJ, Katherine Hignett, 18 March 2020

HSJ reports that the National Institute for Health and Care Excellence’s deputy chief executive will replace founding CEO Sir Andrew Dillon, after he steps down this month. Gillian Leng, who is currently also the body’s director of health and social care, will begin the role on 1 April 2020.

Sir Andrew announced he would retire from the watchdog, which advises on the cost-effectiveness of treatments, in August last year. He has helmed NICE since its inception in 1999.

Professor Leng is also a visiting professor at King’s College London and has worked on clinical trials, epidemiological research and as a consultant in public health medicine.

Meanwhile, the government has been vetting candidates for the role of NICE chair, having appointed existing non-executive director Tim Irish as interim in January.

 

Parliamentary Coverage

The Future Relationship with the EU – The UK’s Approach to Negotiations

HM Government, February 2020

On 31 January 2020 the United Kingdom left the European Union and the Withdrawal Agreement concluded with the EU entered into force. On 31 December 2020, at the end of the transition period provided for in that agreement, the UK will fully recover its economic and political independence. The

UK will no longer be a part of the EU Single Market or the EU Customs Union.

Against that background, this paper sets out the UK’s approach to the negotiations with the EU that will begin shortly. It does not deal with issues relating to the implementation of the Withdrawal Agreement.

The paper can be accessed here.

House of Commons – Written Question Tabled, 18 March 2020

James Murray (Ealing North): To ask the Secretary of State for Health and Social Care, if he will make it his policy to recognise the marketing authorisation by the European Medicines Agency of any coronavirus (2019-nCoV) vaccine to ensure there is no risk of delay in the UK acquiring the vaccine in comparison to countries in the EU.

House of Lords – Oral Question, 18 March 2020

Baroness Thornton: To ask Her Majesty’s Government what assessment they have made of the shortage of supply of (1) contraceptives, and (2) hormone replacement therapy drugs, in the United Kingdom, and when they expect that the normal supply of these products will resume.

The full transcript can be viewed here.

 

Full Coverage

Will coronavirus lead to drug shortages for the NHS?

The Guardian, Andrew Hill, 19 March 2020

The coronavirus pandemic has increased the risk of shortages of several essential medicines. Raw materials for many key drugs, such as antibiotics and statins, are manufactured in China, where factories have been disrupted by efforts to contain the virus. Will this mean shortages for the NHS?

The drug supply chain relies on what are known as “active pharmaceutical ingredients” – the basic molecules used to make drugs. These raw materials are manufactured in China and then exported to India and other countries where they are formulated into tablets or injections, for sale worldwide. Indian companies procure 70% of their raw materials with ingredients from China, where manufacturing is cheap. The NHS imports 80-90% of its drugs supply from abroad, and 25% of its generic drugs from India.

At the height of the Chinese Covid-19 epidemic, Chinese factory production was stopped. Workers were quarantined and transport between factories was disrupted, so key raw materials weren’t produced. After supplies of Chinese raw materials ran out, companies in India and elsewhere could no longer produce and export the same volume of medicines.

In response to shortages, India decided to provide its people with essential medicines first. The country recently banned exports of key medicines such as antibiotics, statins and paracetamol. In the long-term, this could wreak havoc on the NHS supply line. Although some Chinese factories have reopened, it is unclear when production will be fully restored, or when India will lift its restrictions on drug exports.

In the short-term, as a result of no-deal Brexit planning, the NHS has a reserve supply of drugs to prevent shortages occurring. But these contingency plans won’t last forever.

We have seen drug shortages in the past, albeit on a smaller scale. In 2008, after Chinese factories closed near Beijing for three weeks during the Olympic Games, there were shortages of raw materials. In 2019 an epidemic of swine flu in China depleted the global supply of heparin, an essential medicine to prevent heart attacks. In Puerto Rico, Hurricane Maria damaged another factory making heparin, which disrupted supplies of the drug in 2017.

The effects of coronavirus will last for months, and will expose the vulnerabilities of our drug supply chain. We need to apply new stress tests to the NHS drug supply chain. How will the NHS cope if Chinese supplies are continually disrupted? How will it be affected by disruptions to supplies of drugs from other countries, such as Italy? For each essential medicine, are there alternative suppliers in other countries? And are there alternative drugs that patients could take if one drug is no longer available? Stress tests were applied to the banking system after the financial crisis of 2008. Our supplies of medicines are equally important, and should be tested in similar ways.

Instead of relying on imports, we should re-evaluate the case for manufacturing more medicines in the UK. Britain has a long history of pharmaceutical development. During the second world war, Glaxo Laboratories in the UK manufactured 7.5 billion tablets of penicillin a year. Now, however, both the UK and US depend on supplies of penicillin from China.

Human trials for a coronavirus vaccine will begin in April – but before a vaccine is ready, we will need to ensure that key drugs to treat the symptoms of coronavirus are available for everyone who needs them. Pilot studies from France and the US suggest that hydroxychloroquine can lessen the severity of coronavirus infection. A clinical trial in Shanghai is currently evaluating whether pirfenidone could improve lung function for people with severe disease. More definitive clinical trial results of these and other drugs are expected in May and June.

These drugs are already being manufactured in other countries. But the acute worldwide demand for drugs to treat coronavirus could easily outstrip supply. In times of shortage, other countries could stockpile their supplies to treat their own people. Like India, they may be unwilling to export drugs to the UK.

Supply chains are only as strong as their weakest links. If new treatments for coronavirus emerge in the next few months, the UK can’t afford to be the last link in a vulnerable chain. The government has already requested that UK companies manufacture more ventilators and protective masks. It should do the same with the UK pharmaceutical industry, repurposing factories to produce drugs that help treat coronavirus and any other essential medicines at risk of shortage.

Andrew Hill is a senior research fellow in the Institute of Translational Medicine at the University of Liverpool.

NHS England: Pharmacy income protected during COVID-19 pandemic

C+D, Valeria Fiore, 18 March 2020

NHS England has pledged to protect pharmacies’ income as the UK prepares for the “peak” of the COVID-19 outbreak.

English community pharmacies’ income will be protected if dealing with the virus means that “routine contracted work has to be substituted”, NHS England CEO Simon Stevens and NHS chief operating officer Amanda Pritchard said in a letter to healthcare professionals yesterday (March 17).

Specific guidance on this will be issued in due course, along with advice on how to claim for additional funding to cover the costs of responding to the outbreak.

Clinical commissioning groups (CCGs) will also be reimbursed for payments to pharmacy contractors who need to close for coronavirus-relates issues, according to the letter.

“Financial constraints must not and will not stand in the way of taking immediate and necessary action – whether in terms of staffing, facilities adaptation…or any other relevant category,” the letter said.

Recording costs

Healthcare providers and commissioners are advised to “carefully record the costs incurred in responding to the outbreak and will be required to report actual costs incurred on a monthly basis”.

It is “crucial” that accurate financial records are kept during this time, the letter stressed.

“To support reimbursement and track expenditure we will in due course be asking all relevant organisations to provide best estimates of expected costs from now until the expected end of the peak outbreak. We will provide further guidance with relevant assumptions in order to support you in making these estimates,” it said.

Reimbursement for CCGs

NHS England is taking action now because it predicts that “the NHS will still come under intense pressure…at the peak of the outbreak”, the letter said, basing this assumption on how other countries tackling the virus have fared.

CCGs will be reimbursed, “where required”, for services such as an “NHS urgent medicines supply service for patients whose general practice is closed”.

Costs will also be covered for a “medicines delivery service” to support patients who have contracted the virus and “vulnerable patients” who are self-isolating in their homes.

The news comes after the Pharmaceutical Services Negotiating Committee CEO Simon Dukes said earlier this week (March 16) that some pharmacies closing due to staff sickness during the COVID-19 outbreak “may not open again” as they lack the funds to re-open.

Flexible approach

Royal Pharmaceutical Society (RPS) English Pharmacy Board chair Claire Anderson welcomed NHS England’s “flexible approach”, noting that it would “come as a relief to many”.

“It’s vital that income is protected when contract work has to re-focus on COVID-19 to care for patients. This kind of financial lifeline is important to preserve the future functioning of the community pharmacy network,” she said.

“We look forward to seeing further detail on this as how and when it’s implemented will be vital.”

COVID-19: NI pharmacists to halt industrial action to deal with crisis

C+D, Nora Elias, 18 March 2020

Contractors in Northern Ireland are halting plans to take industrial action as thousands more patients present at pharmacies every day in the midst of the COVID-19 crisis.

Community Pharmacy Northern Ireland (CPNI) has announced that planned industrial action, which its members voted in favour of last month, has been put on hold as a result of the pandemic.

A spokesperson for the representative body told C+D on Monday (March 16) that the measure has been postponed “for the foreseeable as community pharmacy plays an integral role in getting everyone through coronavirus”.

Some pharmacies in the country are currently dispensing around four times as much medication in a week as they normally would, the CPNI added.

The representative body urged the public to show understanding of the mounting pressure pharmacies are under due to COVID-19 and to “work with the new arrangements pharmacies are having to introduce in order to deal with the surge in patient and prescription requests”.

Managing supplies

The CPNI also issued a request to the general public to “understand that services may need to be restricted to prioritise those most in need as pharmacy teams manage supplies of medicines”.

Speaking after an emergency CPNI meeting, chief executive Gerard Greene said on Monday that the situation for pharmacies has been “compounded by the fact that a lot of GP surgeries have closed to the public”.

Mr Greene also echoed official guidance for patients not to visit a pharmacy if they are displaying symptoms of COVID-19, to “avoid putting pharmacy staff and other patients at risk”.

“If your symptoms worsen during your home isolation or you are no better after seven days, seek medical advice by telephone,” he added.

Mr Greene also emphasised the importance of patients not stockpiling drugs during the outbreak, commenting that “the public…should be assured that pharmacies are working hard to manage the stock levels”.

“Everyone has a role to play in ensuring that medicines and prescriptions are not over-ordered. We must all think of each other to ensure that there are enough medicines for everyone and especially for those in our community who are most in need,” he explained.

“Biggest societal challenge in our lifetime”

In a statement released yesterday (March 17), Northern Ireland’s health minister Robin Swann said the COVID-19 outbreak represents the “biggest societal challenge in our lifetime” and asked for the public to show consideration for healthcare staff on the frontline.

“I would urge everyone to be patient with staff who are working through unprecedented pressures,” he said. “Please respect and give space to nurses, doctors, pharmacists, social care staff…and everyone working across the system.”

Responding to the health minister’s statement yesterday, CPNI outlined new measures that would be put into place to help Northern Irish pharmacies deal with the crisis.

“We will be changing how we work in community pharmacy and would ask for public support to manage this: there will be significantly reduced access to pharmacies. Access will be restricted to keep low numbers inside pharmacies,” Mr Greene said.

New counters are also being put in place in many pharmacies as a means of putting social distancing into action, he added.

During this time, patients should also allow pharmacies more time to get their medication ready, giving them “up to 48 hours to get repeat medicines ready for collection once forms are handed into the pharmacy”, he said.

NICE finds new chief to replace retiring founder

HSJ, Katherine Hignett, 18 March 2020

The National Institute for Health and Care Excellence’s deputy chief executive will replace founding CEO Sir Andrew Dillon, after he steps down this month.

Gillian Leng, who is currently also the body’s director of health and social care, will begin the role on 1 April 2020.

Sir Andrew announced he would retire from the watchdog, which advises on the cost-effectiveness of treatments, in August last year. He has helmed NICE since its inception in 1999.

NICE has been searching for a new chief executive officer since last autumn. HSJ has approached the body for more details about the recruitment process.

Professor Leng, who has been deputy chief executive since 2007, said in a statement: “Under Andrew’s leadership NICE has gained a formidable reputation both nationally and internationally as a world leader in guidance development.

“I am honoured and privileged to have been appointed as its second chief executive. I look forward to working with the Institute’s staff and stakeholders as we enter an exciting new chapter of innovative changes to deliver our portfolio of guidance into the hands of front-line staff in an easy and intuitive way.”

Professor Leng is also a visiting professor at King’s College London and has worked on clinical trials, epidemiological research and as a consultant in public health medicine.

Meanwhile, the government has been vetting candidates for the role of NICE chair, having appointed existing non-executive director Tim Irish as interim in January.

The Commons health and social care committee backed former BBC executive Sharmila Nebhrajani to take on the role after a hearing earlier this month. Ms Nebhrajani has been chief executive of groups including Wilton Park, a forum owned by the Foreign and Commonwealth Office, and the Association of Medical Research.

Media And Political Bulletin – 19 March 2020

From Factory to Pharmacy

As part of our mission to build awareness, understanding and appreciation of the vital importance of the healthcare distribution sector, we developed an infographic explaining the availability of medicines. It identifies the factors that can impact drug supply, as well as the measures that HDA members undertake day in, day out to help mitigate the risks of patients not receiving their medicines.

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