UK Faces Severe Risks in Medical Supply Chain, Report Warns

The United Kingdom is “perilously vulnerable” to disruptions in the supply of critical medical countermeasures, according to a report from the Centre for Long-Term Resilience (CLTR). The think tank warned that shortages of key supplies, including antimicrobials, vaccines, and diagnostic tools, could leave the country unprepared for biosecurity threats.

The report highlighted that the UK is now less prepared to handle biosecurity risks than it was at the start of the COVID-19 pandemic.

Decline in UK Manufacturing

The findings were based on interviews with senior civil servants, academics, NHS England supply chain experts, pharmaceutical companies, and experts in manufacturing and business resilience.

The report detailed a decline in UK life sciences manufacturing volumes in the UK between 2009 and 2021, alongside fragile supply chains and depleted buffer stocks.

One example is the UK’s heavy reliance on China for the active pharmaceutical ingredient (API) in gentamicin, a vital antibiotic used to treat serious infections, including meningitis. Any geopolitical event resulting in API export bans “would also wipe out UK access”, the report warned. 

Critical Window to Build UK Resilience 

Co-author Dr Cassidy Nelson, head of biosecurity policy at CLTR, described the UK as “perilously vulnerable to disruptions in the delivery of critical health supplies”. 

She highlighted the lack of transparency in pharmaceutical supply chains, as companies are not required to disclose API sources. “As the government seeks to re-build our defence industrial base, it must also consider our strategic vulnerability in the pharmaceutical space,” Nelson said in a press release.

Co-author Dr Paul-Enguerrand Fady, PhD, CLTR’s biosecurity policy manager, said the government has “a critical window” to build the UK’s resilience. “We need smart, joined-up policymaking,” he said.

Fady explained to Medscape News UK that the UK was previously less dependent on China for the supply of medical countermeasures. “Successive administrations made the active choice to allow private companies to offshore manufacturing of medical countermeasures from the UK as part of an overall de-industrialisation programme.” 

These companies rationalised costs because labour and input charges were much lower in China, and the Chinese government promoted policies to foster API manufacturing to gain a competitive advantage. Fady cited as an example the API for the antibiotic aztreonam, which is currently in jeopardy due to “extremely concentrated supply from a single factory in Venezuela”. 

Transparency and Contamination Risks

The report called for increased transparency in pharmaceutical supply chains. Other healthcare product regulators, such as New Zealand’s Medsafe, require pharmaceutical companies to disclose all manufacturing locations, making this information publicly available, he said. “This allows for much greater transparency and visibility. We need the same in the UK.”

Other risks of overreliance on concentrated supply include potential contaminants. For example, in 2019, ranitidine was found to contain N-Nitrosodimethylamine (NDMA), a carcinogenic impurity generated as a breakdown product of the intact API. The drug was then withdrawn from the market by most Western health authorities. “It was only once the recall of specific products was initiated that the wider community realised that there were just two providers of the API worldwide, and that one source was reliant on the other,” Fady told us. So, the drug effectively had to be pulled from the market altogether in the UK.

Key Recommendations 

The report outlined five key recommendations:

• Develop a government strategy for securing critical medical countermeasures.
• Improve supply chain transparency.
• Diversify sources of materials and subcomponents.
• Strengthen UK-based life sciences manufacturing.
• Establish a national stockpiling taskforce.

It also urged ‘de-siloing’, with cross-departmental collaboration. Fady said a lack of shared data platforms limits coordination across government agencies. “There is a real role for the Cabinet Office… to convene, mediate, and facilitate collaboration across departments.”

He noted that the recent announcement to merge the work of NHS England into the Department of Health and Social Care might help break down bureaucratic silos and improve information-sharing. “The creation of an integrated supply chain data platform would also go a long way to increasing preparedness for biological events and mitigating biological risks,” Fady suggested.

Expert Insight

Dr Emilia Vann Yaroson, PhD, a lecturer in operations and supply chain management at Sheffield University, offered a cautious perspective on the report’s findings. She told Medscape News UK that a stakeholder event held at the Royal Pharmaceutical Society in November last year – at which she spoke – “highlighted a more optimistic outlook for the future”.

The event acknowledged that despite an increasing focus on difficulties in access to medicines, with regulatory developments such as anticipatory reporting of supply issues, “we still seem to be experiencing shortages of many product lines on far too frequent a basis”. Moreover, “no country seems to be exempt from this pain, regardless of the possible wealth of manufacturing capability”, Yaroson noted. 

“The pharmaceutical supply chain is a complex and adaptive system composed of multiple interacting stakeholders,” she said. Consequently, building resilience is not always straightforward – some strategies may have unexpected downsides for certain stakeholders – and therefore there is no single solution to prevent shortages. “However, improving transparency and visibility through clear communication, reliable contracts, and targeted training can help create a stronger, more adaptable supply chain,” Yaroson said. 

Yaroson declared no conflicts of interest. 

Dr Sheena Meredith is an established medical writer, editor, and consultant in healthcare communications, with extensive experience writing for medical professionals and the general public. She is qualified in medicine and in law and medical ethics.