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COVID-19 has exposed numerous weaknesses in the United States by showing massive dependence on other countries. The relationship between the U.S. and China has been turbulent at times to say the least, but our dependency on them for pharmaceuticals is extensive.

“We are at the mercy of others when it comes to computer chips, but we are the world’s largest exporter of raw materials for vitamins and antibiotics. …Should we reduce the exports, the medical systems of some Western countries will not run well…” said Dr. Li Daokui, economics professor at a conference in China.

This comment points out America's dependence on foreign powers to meet our prescription drug needs.

According to a study by the Mayo Clinic, 70% of Americans are on at least one daily prescription, 20% are on five or more daily.

The issue is not where do we purchase cheap clothing or less substantial things, but items which are required for our survival and success in both war and peace.

Do you wonder where that medicine comes from?

“As of August 2019, only 28 percent of the manufacturing facilities making APIs to supply the U.S. market were in our country,” said Janet Woodcock, director of the Center for Drug Evaluation and Research at the Food and Drug Administration, during a congressional hearing on Oct. 30.

“By contrast, the remaining 72 percent of the API manufacturers supplying the U.S. market were overseas.”

The majority of generic drugs are provided by India who according to a 2014 study by the Boston Consulting Group, gets more than 90% of active pharmaceutical ingredients and intermediate ingredients from China.

Rosemary Gibson, author of China Rx: Exposing the Risks of America's Dependence on China for Medicine and senior adviser with the Hastings Center said “If China shut the door on exports of core components to make our medicines, within months our pharmacy shelves would become bare and our health care system would cease to function.”

“We've learned a good lesson. This pandemic has underscored the vital importance of re-shoring our supply chains and bringing them back into the United States where they belong, where they should have never left,” President Donald Trump said at a press conference.

In an interview with The Financial Times, Peter Navarro, White House Trade Advisor said, “This is a wake-up call for an issue that has been latent for many years but is critical to U.S. economic and national security. If we have learned anything from the coronavirus and swine flu H1N1 epidemic of 2009, it is that we cannot necessarily depend on other countries, even close allies, to supply us with needed items, from face masks to vaccines,”

Navarro expanded on this in an interview with Fox Business saying we need to “think about how we can get our pharmaceutical production back onshore and cheap.”

In March, the Trump administration started to prepare an executive order in hopes that an increased demand for drugs and medical products made in America would create incentives for companies to produce domestically.

The order hopefully will include labeling for offshore products. One pharmacy technician who wished to remain anonymous said that they cannot see the country of origin when ordering medications from wholesalers, but when they receive them, notate country of origin on the box and use that information for future orders.

“As President Trump has said, what we need to do is bring those jobs home so that we can protect the public health and the economic and national security of the country.” Navarro stated in another interview.

In a press conference Trump said,  “We're bringing supply chains back home and we've learned a lot about supply chains. We've learned it's nice to make things in the U.S.”

Puerto Rico was previously a substantial U.S. drug manufacturing supplier and could be again. In order to encourage manufacturers to set up, a tax break was created in the 1970's. Former President Bill Clinton revoked that by signing a law into effect in 1996 that phased them out completely by 2006. This caused manufacturers to flee and was the beginning of a deep recession in Puerto Rico, according to local economists after the elimination of Section 936 of the Internal Revenue Code Pharmaceutical employees dropped from 26,000 to 17,000 and without a section 936 type incentive it was doubtful big companies in pharmaceuticals would return.

Reestablishing Pharmaceutical manufacturers incentives in Puerto Rico could help an island with over 3 million U.S. citizens and increase our national security by manufacturing in U.S. territory.

One of the final considerations is when it comes to “buy American,” Americans need to be willing to fund it. When there were shortages at the grocery store, some started attending farmers markets as an alternative, yet in normal times many find them cost prohibitive. If Americans do not fund local and American-based companies, they will not be there when needed. If America is going to reduce dependence on other countries, it is going to take American dollars.

Local pharmacists talk about pharmaceutical dependence

Local pharmacists said in the past when there was a disruption in the supply, in spite of it taking a month or so, other manufacturing sources step up to fill the gap. If it was a medication that only had one manufacturer than a delay may occur, but alternative manufacturers would be created although it may take some time.

In the event that a quality control issue or disruption in supply was to occur local pharmacist Craig Stevens said he felt confident it would be resolved.

“We find a way to fix it,” Stevens said. “There are too many safeguards in place.”

Other countries provide cheaper products, but also do not have to follow the same regulations.

The system of checks and balances is extensive through the FDA with multiple agencies and paperwork set up as a safeguard. This is where the confidence of pharmacists comes from according to Stevens. The confidence is in the system itself.

However, since pharmacists cannot sell drugs they don't have, they are taking a keen interest and monitoring the situation.

“It's on our radar,” another local pharmacist said.

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