And to put this interpretation into perspective, people that need this drug for diseases that it has proven to have a large effect on are losing access to it because it may or may not help with COVID-19.
The original article has no such problem. Yet the person I replied to could be interpreted as "wait, maybe its still good!". My comment makes zero sense as a reply to the original article.
This is mostly a technical problem of how comment trees that get extremely heavy having no natural way to divide themselves. Sometimes we prune them, and when we do that, we try to do it in a non-lossy way.
Guardian article - https://www.theguardian.com/world/2020/mar/27/vital-drug-peo... .
It cites someone from Lupus UK. Their page at http://www.lupusuk.org.uk/uk-azathioprine-supply/ says "we have received reports from a number of people with lupus who have been unable to fulfil their prescription of azathioprine" and that "stocks are in the process of being replenished and should be available in the UK in mid-April".
Comment from an HN'er:
"For several weeks my mother hasn't been able to fill her regular prescription for hydroxychloroquine that has been an important part of managing her lupus for >30 years." - https://news.ycombinator.com/item?id=22793293
It may be that the answer to these questions is "yes," but that answer seems to be being assumed right now.
Since the questions #1 and #2 can be answered both "yes" and "no", with equal merit, I suggest that perhaps they are not useful questions.
That is, not every pharmacy in every country is out, and sometimes a pharmacy is out of a medicine. If that's what you mean by "universal" and "local shortage before" then you're being absurd.
Bear in mind that I was answering beaner's question, not making some broader statement.
Did you really mean "universal" to mean every pharmacy in the world, and did you really mean "Have there been shortages" to include a single pharmacy somewhere running out? No. But how am I supposed to know what you do mean?
Your questions did not seem informed by the information in the links I presented, which suggests a different sort of bias.
So while you could doubt such a story for other reasons, the causal linkage is being made explicitly in at least some instances.
If there’s a risk of a supply run, it would definitely not last very long. For many people there’s alternatives for treating arthritis and lupus.
If it’s shown even to improve the patient’s outcome by even just 10% or more (as this study suggests), every country should be ramping up production of it right now instead of letting it be politicized.
Unlike off-patent prescription drugs.
"Covid-19 Could Bring Generic Drug Manufacturing Back to the U.S., Analyst Writes"
https://www.barrons.com/articles/covid-19-could-bring-generi...
You're dropping the context of the hard decisions nations and governments actually deal in day to day, year to year when it comes to budgets. That's why not a single country had a proper stockpile of N95 masks for a pandemic like this. That isn't an exaggeration: literally not one nation had enough of a stockpile for this scenario, that includes South Korea, Japan, China.
To say that nobody thought to do it is outlandish. As one example Congress set aside funds in 2006 to stockpile 100 million N95 masks. That's not strange, as many people were aware of the need to maintain such a stockpile. There is a big difference between being aware of the need, proposing plans and spending for it, and actually getting billions of dollars on a recurring basis to maintain the necessary proper stockpile perpetually with no event to push it with (yeah but we had a flu pandemic in 1957! try selling that premise). That's the actual reality of budgets and governments.
It's expensive to maintain a persistent minimum stockpile of 1 billion non-expired N95 masks to cover the US population and the demand the US has seen. If it's a year-long pandemic, a billion masks isn't enough. You need several billion masks in that scenario. Coming out of the great recession, that is a very hard budget decision for all nations. And the fact is, most nations can't afford to do it at all. The easy retort of course is to say, well, look at the damage from this virus compared to that cost for masks. That's purely hindsight spouting that tries to pretend a comprehensive reality doesn't exist and that people who make budgets don't have to deal with difficult decisions every single year (while not factoring in every possible bad scenario every time they make a budget).
And let's not pretend it's enough to stockpile masks, regarding spending allocations. If we're doing hindsight fantasy, let's be correct about it. You need to constantly maintain a lot of other gear and training for a pandemic, costing large sums of money. In an ideal scenario a nation the size of the US should probably have over a million ventilators stockpiled, just in case. We should probably maintain 2x or 3x the ICU capacity we have, on a persistent basis and at a large cost.
This isn't an argument against being more prepared. Of course every nation should have a vast magical stockpile of N95 masks that never depletes, even the ~140 poor nations of the world that can't afford to do it. The point is, it's difficult to convince any nation to do it at the required persistent scale, and most can't afford to do it regardless.
I think there is an alternative solution, though: Rather than maintaining a gigantic stockpile large enough to last a multi-year pandemic, it might be more efficient to maintain a modest stockpile sufficient for the breakout phase along with ready-to-deploy crash production capacity. This might be significantly cheaper.
This means that we need to ensure that we have the capacity to 100x, 1000x, 10,000x production--whatever is modeled to be enough to meet ongoing demand during a pandemic--within the time bought by drawing down the strategic reserve.
We don't need to maintain and refresh a complete stockpile of finished goods, or even a complete stockpile of production capacity (suitable factory floor space, meltblown nonwoven fabric equipment, etc.). We just need to know where such things exist that can be quickly directed to the desired use either with cooperation from the owner or with the DPA, how much exists naturally, and only if there is a deficit, to maintain a stockpile sufficient in combination with those identified supplies: Government-owned sterile factory floor space, for example, or spare production lines for meltblown nonwoven fabric.
We can even enlist private companies to maintain the stockpile for us. It makes way more sense to just subsidize e.g. 3M to have lots of extra meltblown nonwoven fabric production capacity. They are in the business, they maintain and operate the machinery and have the know-how and commercial connections to produce and distribute the material. They will have the capability to quickly respond to demand spikes if the capital requirements for increased production capacity already exist thanks to Uncle Sam's foresight.
Finally, what is maybe even more important than stockpiles or production capacity subsidies is the organization this exercise entails (knowing who makes what critical parts in the supply chain, where they are, what their production capacity is and how quickly it can grow, etc.), which gives an ability to rapidly marshal resources and eliminate inefficiencies to surge production as quickly as possible.
Sure in the long run it may be relatively easy to manufacture enough HCQ. But right now stocks are running extremely low because people are trying to use it for COVID without any scientific basis.
1: It’s probably the bullwhip effect and hysteresis in the supply chain but that’s speculation on my part.
Besides, by requiring a prescription you’re negating the ability for people to hoard. And a single pallet of HCQ is enough to treat thousands of people.
I really hope you look into how easy to manufacture and abundant HCQ is. It’s important to combat media scaremongering.
You mean the country that, more than a month ago, restricted exports of many drugs and chemicals used to make drugs (the so-called Active Pharmaceutical Ingredients). Your local end of the pharmaceutical supply chain can't deliver drugs that can't be made anymore.
Also, this study does NOT suggest that patient outcome is improved by 10% or more. Not in any way. Fewer patients died within the timeframe of this study, but more patients on the drug experienced ARDS; not to mention that 9 patients had to be removed from the study due to cardiac effects of the drug.
In general, that doesn't mean we should simply abandon all attempts to de-politicize it. In fact, it means just the opposite - we should put aside any political aspects and focus on objective data.
As of the last time I talked to her a couple days ago, my mother still hasn't been able to fill her hydroxychloroquine prescription that she has used to treat lupus for over 30 years. The alternative medications are steroids such as prednisone, which have previously caused dangerous side effects. Due to the useless panic buying, she's is now at severe risk of a bad autoimmune reaction if anything activates her immune system (even from a mild cold; covid-19 would be fatal).
> every country should be ramping up production of it right now instead of letting it be politicized
Yes, they should, but before that happens while supplies are limited, there are people that need the drug for well-established reasons.
The world largely moved past quinine for battling malaria quite a while ago. In fact, chloroquine is all but banned in my country now.