This is an excerpt of an article originally published by Healthbeat, a nonprofit newsroom covering public health published by Civic News Company and KFF Health News.
The world’s conflicts rarely stay confined to the map.
The Iran war is scrambling medical supply chains globally, because the Persian Gulf is not just an energy chokepoint but a critical transit hub for pharmaceuticals.
The Iran war is a drug shipping fiasco
The starkest warning yet of how the Iran war could scramble global health comes from this must-read analysis in Think Global Health. The short version: The war is choking the movement of medicines around the world.
It’s not that Persian Gulf countries (like Saudi Arabia, Qatar, and the United Arab Emirates) are major drug producers. They’re not.
It’s that these countries form “a critical pharmaceutical transit hub,” where drugs and their basic ingredients from India, Europe, and China routinely pass before heading to Africa, Asia, and the United States.
For reference, this is a region whose pharmaceutical industry is worth $23.7 billion. But roughly 80% of that trade depends on medicines or pharmaceutical ingredients passing through.
And right now both ways these medicines largely transit, the sea-shipping lane in the Strait of Hormuz and the Persian Gulf’s giant cargo airports, are badly disrupted. Shipping has dropped “90% below pre-war levels,” while air cargo capacity has fallen by “79% in the Gulf region.”
In New Orleans, pharmacist Ruston Henry from H&W Drug Store, the independent three-store New Orleans pharmacy, still remembers the pandemic delays. “During COVID, everything was slow,” he said. But to date, he said, his family’s pharmacies haven’t yet experienced any Iran War changes in pharmaceuticals or vaccines from the wholesalers who supply his family business.
Where will the shocks be felt first?
Delayed medicine; shortages of helium needed for MRIs
Healthbeat reached out to ask one of the authors, Prashant Yadav at the Council on Foreign Relations, who is a leading expert on global health care supply chains.
Right now the biggest risk is cold-chain medicines, which Yadav writes are “vaccines, insulin, biologics, and cancer therapies” with “short shelf lives” that have to move quickly and stay within a tight temperature range; largely “between 2°C and 8°C,” which is 35-46°F.
Most cold-chain medicines move by air cargo, Yadav told Healthbeat, and airlines cannot simply add new capacity overnight if those routes stay disrupted. Even over the medium term, “I don’t think European airlines, or the two major African ones that have stepped in, will enhance their cargo carrying capacity by buying new planes just because this may continue for a few more months,” he said.
When shipments of these drugs are held up, those medicines can spoil. And even when they don’t, delays multiply. As the article notes, cargo carriers “need a week and a half to catch up for every week that air shipments are suspended.”
Also at risk are supplies of helium, a gas that is “an essential input for cooling the magnetic resonance imaging (MRI) machines used worldwide for [over 95 million] medical scans,” each year. Qatar alone produces a third of the world’s helium. And the threat is not just constraints from the transit fiasco, but physical damage to the industry, including Iran’s March 18 attack on a major helium production site in Qatar.
Yadav believes we will ultimately see some “supply impact for MRI helium,” but exactly how severe it may become is too hard to untangle right now. Much will depend on how long Qatar’s production remains offline and how exactly limited supplies are allocated between industries, like semiconductor manufacturing (which is an enormous use for the gas).
Threatened medical research, increased drug costs
Perhaps unexpectedly, the war has also put medical research under threat. Yadav’s article describes how the Gulf region was in the middle of a clinical trial boom, driven by “the area’s high chronic-disease prevalence and its lenient regulations allowing for fast-tracked trials,” and that supply chain chaos could interrupt ongoing trials.
The good news is that, for now, “short-term risks of drug shortages are low in most countries,” Yadav writes. But that’s because of “inventory buffers” that governments and pharmaceutical companies keep around the world. But those cushions are temporary. If shipping and air freight disruptions drag on, shortages will eventually work their way through the system.
Could the war could trigger a price squeeze for medicines made with petroleum products, which is more than you might think? “Most of our medicines have some kind of a chemical precursor, and a very significant portion of those chemical precursors are petrochemical derivatives,” Yadav told Healthbeat. (For example, acetaminophen and ibuprofen are made using an oil-based chemical called propylene.)
But Yadav says, for now, that’s not a major concern. The petrochemical ingredients in something like a pill of ibuprofen only make up only around 5% of the cost, with the rest tied up in processing and manufacturing.
But other cost implications are coming fast.
A combination of rerouted flights, rising air-cargo rates, and surging insurance premiums for ships mean that moving medicines are more expensive everywhere. And at least one supply chain logistics firm says that, “consumers could see drug costs affected within four to six weeks.”
Yadav’s article ends with a clear policy warning. Governments may need to temporarily loosen certain import regulations so medicines can move through alternate routes. Longer term, he says the world needs something bigger: a standing G20 coordination system that tracks where medicines are stuck and helps countries respond before shortages hit.
William Herkewitz is a reporter based in Nairobi, covering global public health for Healthbeat, a nonprofit newsroom covering public health published by Civic News Company and KFF Health News Every week, in the Global Health Checkup, Herkewitz highlights some of the week’s most important stories on outbreaks, medicine, science, and survival from around the world. Contact William at wherkewitz@healthbeat.org. Sign up for Healthbeat newsletters here.
