This column is an opinion by Dr. AbdulGhani Basith, an emergency physician in Toronto and a faculty member at The Schulich School of Medicine & Dentistry. He is a co-founder of The Critical Drugs Coalition, a group of pharmaceutical experts, physicians and others working to prevent future drug shortages in Canada. For more information about CBC’s Opinion section, please see the FAQ.
For months now, Canadians have been sacrificing things we never thought we would have to and giving up more than we ever thought we could. Those sacrifices are paying off — they’ve helped flatten the curve, and our hospitals are able to keep up with the burden of this terrible virus.
However, while we have survived this leg of the race, we must recognize that COVID-19 is a marathon that will continue to tax our health care system, and that it is creating the potential for drug shortfalls on a level that we may not be prepared to deal with.
This applies to critical medications as well as potential COVID-19 treatments and vaccines. The federal government needs to publicly and openly take action now to secure our supply of critical care drugs, so that front-line health care providers can continue the work of tending to the sickest patients.
Part of taking care of critically ill people depends on medications that are routinely used in emergency departments and intensive care units all over the world. Medications such as norepinephrine can help support a patient’s blood pressure, while others such as propofol and fentanyl help sedate patients on ventilators or undergoing painful procedures.
Without these medications in my ER, we would not have been able to save the life of an otherwise healthy female patient recently whose respiratory system could no longer handle the damage done by COVID-19. We also would not have been able to honour the wishes of an 85-year-old grandmother who was not able to be with her family during her final moments from pneumonia, and who wanted to die with dignity and comfort.
Although these medications are not currently in short supply, the long-term situation is tenuous due to issues with global supply chains as the pandemic rages on.
In fact, over the past few months Canada has had numerous supply issues, many of which have been identified on the Tier 3 drug shortages list run by Health Canada that details those which could have serious consequences for the health care system.
Currently, the vast majority of the drugs on the Tier 3 list (24 of 32) are essential for treating COVID-19. Recently, for example, the drug propofol has had to be imported in non-traditional concentrations. The implications for errors are obvious, and have led to alerts from pharmacists to ensure that physicians are taking care with the new concentrations.
The anesthetic propofol is often used to sedate COVID-19 patients when they are put on ventilators. (Richard Vogel/The Associated Press)
We have also been facing shortages of non-injectable drugs — ventolin (the “blue puffer” as it’s known to many of our patients) and dexamethasone, a steroid showing tremendous promise for treating the inflammation from COVID-19, being prime examples. Health Canada has been urgently importing ventolin puffers from abroad to fill domestic demand.
Why we face potential shortfalls of these types of drugs is multifaceted. Two of the biggest reasons are the hoarding of drugs by some nations, and the fact that we rely on imported active pharmaceutical ingredients (APIs) with ambiguous supply chains. APIs are the actual precursors for drugs, and their shortage means manufacturers are unable to produce needed drugs in their final form — be it a tablet, an injectable or an inhalable formulary.
Canada relies almost exclusively on imported APIs, and China and India are the leading producers. The supply issues mirror the shortages of personal protective equipment (PPE) that we have all become familiar with over the past few months. We relied heavily on China for vital PPE supplies, and when the COVID-19 pandemic overwhelmed both their own health care and PPE production systems, exports became limited.
Lack of communication
Compounding this is a long-standing lack of information about issues in the global pharmaceutical supply chain.
Drug shortages have been the norm for many years for pharmacists, and they often aren’t given advance notice of pending international supply problems. They find out about specific drug shortages only when trying to order more medication from a manufacturer, and are often forced to put together bits and pieces of information as they try to figure out a solution because they aren’t privy to the full global supply-chain picture.
Pharmacists often find out about specific drug shortages only when trying to order more medication from a manufacturer. (Sue Ogrocki/Associated Press)
This concern has only become worse as COVID-19 limits the export of many drugs from major manufacturers abroad. This is why the Canadian Pharmacist Association placed 30-day limits in March on prescriptions that normally may have gotten 90-day supplies, to ensure all patients would have the medications they needed on a daily basis. This limit is now being lifted as China’s API production picks back up.
The federal government has created a website, drugshortages.ca, to help streamline the communication of this kind of information, but many pharmacists feel it is not user-friendly and it does not provide alerts about pending shortages.
Until we have a reliable domestic supply of these types of drugs, the government could achieve better transparency by instituting public policy that mandates disclosure of all aspects of the logistics of API imports.
However, on a global scale the distribution of medications often goes to the highest bidder. With the advent of novel therapies for COVID-19, we are seeing hoarding of some essential medications. Hydroxychloroquine was an early example, and most recently, the U.S. Government purchased 100 per cent of the world’s supply of the antiviral drug Remdesivir from Gilead Pharmaceuticals, a medication that may have some benefit for the treatment of COVID-19.
The U.S. has bought the global supply of remdesivir, an antiviral drug that has been found to help certain patients recover more quickly from COVID-19. 4:20
Ideally, many of these critical-care drugs should be part of Canada’s National Strategic Emergency Stockpile, but it’s clear that we simply do not have enough medications sequestered to meet the demand during the COVID-19 pandemic. Part of this may be due to funding cuts to the maintenance of this stockpile prior to the pandemic. However, it remains that a stockpile is only a temporary measure in the face of a crisis; we need to put systems in place for self-sufficiency around critical health care resources such as the production of important pharmaceuticals.
Unfortunately, Canada is quite limited when it comes to domestic generic drug production. The Sandoz Pharmaceuticals facility in Quebec is the only one in the country that can make injectable drugs, for example, and it is likely not large enough to meet our domestic requirements. Just as we’ve started producing PPE in Canada, we need to create a stronger domestic drug manufacturing sector.
As a country, we have the knowledge and the skills required to manufacture our own pharmaceuticals, and the payoff for the health care system is well worth it.– Source
Bringing pharmaceutical production back to Canada is not easy, nor would it be without consequence. We should expect to see drug prices increase. But while this is a complicated process, it’s not insurmountable. As a country, we have the knowledge and the skills required to manufacture our own pharmaceuticals, and the payoff for the health care system is well worth it.
The lessons of Connaught Labs, the Toronto-based non-profit maker of Frederick Banting’s insulin that also made vaccines, are highly applicable today. Connaught Labs was privatized and sold to Sanofi in the ’80s. The tragedy of this was aptly described in a recent Toronto Star op-ed, as we could have used Connaught Labs for our domestic COVID-19 vaccine supply today, if not for our drug supply.
Nonetheless, we do have a chance to restore domestic manufacturing now. Government support is essential to doing this successfully, and the Critical Drugs Coalition, which I am a part of, is advocating for this as well as for better stockpiling and increased transparency about the drug supply chain. Domestic manufacturing is the most definitive long-term solution to ensure Canada is not in a position where we are reliant on other countries for necessary medications.
The need to ensure a domestic drug supply also extends to vaccines. Eventually we will have a vaccine for COVID-19, and its distribution will be crucial to rebuilding our economy and restoring normalcy to our daily lives.
Gene-based vaccines, which target DNA or RNA, are being tested on humans in the hopes of finding a COVID-19 vaccine. Researchers are optimistic as trials prove successful so far, but they have a long way to go. 2:01
However, when a vaccine comes to market it will strain supply chains to a degree we haven’t seen before. This will be a product that every country will need to restart their respective economies. We cannot afford to be without a robust supply of our own.
The federal government has made investments around research and production of a COVID-19 vaccine, but Canada needs to absolutely ensure we will have the ability to produce vaccines at home. Just as domestic production of APIs allows for self-reliance when global drug shortages occur, the ability to produce vaccines in Canada will also afford us a similar safety net.
We have all lost something during this pandemic, through the innumerable sacrifices made or loved ones who we will never hold again, but we will come out of the crisis stronger. That is who we are as a nation. To ensure our losses and sacrifices haven’t been in vain, and to prepare for future crises, we must fix the cracks in our health care system and become self-reliant in developing and supplying our own domestic pharmaceuticals and medical technologies — not only for the Canadians of today, but also for those yet to come.
BUFFALO, N.Y. (AP) — Hearing the familiar sounds of clacking sticks and pucks banging off the boards and glass while watching Columbus Blue Jackets prospects from the stands of a cold rink on a warm late-summer afternoon was not enough to wash away the lingering residuals of grief for Don Waddell on Saturday.
That, the Blue Jackets’ general manager acknowledged, will take more time than anyone can guess — weeks, months, perhaps an entire season and beyond.
What mattered is how spending the weekend attending the Sabres Prospects Challenge represented a start to what Waddell called among the first steps in refocusing on hockey and the future in the aftermath of the deaths of Columbus star Johnny Gaudreau and his brother, Matthew, who were struck by a suspected drunken driver while riding bicycles on Aug 29.
“We got to play hockey,” Waddell said. “We’re not going to forget about Johnny and his family, the Gaudreau family.”
“Everybody knows that Johnny wants them to play hockey,” Waddell said. “And everybody’s rallying around that.”
The resumption of hockey in Columbus began last week, when most Blue Jackets players returned to their facility to be together and lean on each other at the urging of Waddell and team captain Boone Jenner. And it will continue on Thursday, when the team opens training camp, exactly three weeks since the Gaudreaus were killed.
“Tragic. Senseless. But now we got to focus on trying to get our team ready to play hockey this year,” Waddell said. “We all mourn and heal differently, but I think as a team being together like that is going to be critical for them to get moving forward.”
Waddell was general manager of the then-Atlanta Thrashers in 2003 when Dany Heatley lost control of his car and struck a wall, with the crash killing passenger and teammate Dan Snyder. In 2021, Blue Jackets goalie Matiss Kivlenieks died during a July Fourth fireworks accident.
Waddell placed the emphasis on himself and coach Dean Evason — both newcomers to Columbus this offseason — to guide the team through what will be an emotional season.
“Now, do I think there’s going to be some dark days? I won’t be surprised,” Waddell said.
Reminders of the Gaudreaus’ deaths remain apparent, and reflected in Buffalo on Friday night. A moment of silence was held in tribute to the brothers before the opening faceoff of a game between the Blue Jackets and Sabres.
Afterward, Columbus prospect Gavin Brindley recalled the times he spent with Johnny Gaudreau in Columbus and as teammates representing the United States at the world hockey championships in the Czech Republic in May.
“He was one of the biggest mentors for me at the world championships,” Brindley said. “I couldn’t tell you how many times we hung out with Meredith, pictures on my phone. It’s just so hard to look back and see that kind of stuff.”
The NHL and NHL Players’ Association are providing the Blue Jackets help in the form of grief counseling, crowd security at vigils and addressing hockey issues, such as potentially altering the league’s salary cap rules to provide Columbus relief from having to reach the NHL minimum payroll because of the void left by Gaudreau’s contract.
“The Blue Jackets, I don’t think anybody’s focused from an organizational standpoint, from a hockey standpoint as to what comes next, because I think everybody’s still in shock,” NHL Commissioner Gary Bettman told The Associated Press last week. “I don’t think anybody’s focused right now other than on the grieving part, which is understandable.”
Much of the burden has fallen to Waddell, who has been in discussions with the NHL and the NHLPA and dealing with outreach programs with the Blue Jackets’ partner OhioHealth, while also overseeing preparations for training camp and gauging his prospects in Buffalo.
There’s also his roster to attend to, which he said has two openings at forward, one involving Justin Danforth, who may miss the start of the season because of a wrist injury. Waddell didn’t have to mention the second opening.
Tiring and emotional as it’s been, Waddell found comfort being in his element, a rink, and looking ahead to the start of training camp.
“The guys are in really good shape. We’ve done a lot of testing already and they’re eager to get going,” Waddell said. “We have a reason to play for. And we’ll make the best of it.”
The Blue Jackets later Sunday signed veteran winger James van Riemsdyk to a one-year contract worth $900,000.
“James van Riemsdyk has been a very consistent, productive player throughout his career,” Waddell said. “Bringing him to Columbus will not only provide depth to our group up front, but also valuable leadership and another veteran presence in our dressing room.”
___
AP Hockey Writer Stephen Whyno in New York contributed to this report.
PARIS (AP) — Paris Saint-Germain defender Nuno Mendes was the target of abusive and racist comments on social media after a French league game.
The club condemned the abuse and expressed its “full support” Sunday for the Portugal left back, who was targeted following PSG’s 3-1 win against Brest on Saturday.
Mendes, who is Black, shared on his Instagram account a racist message he received.
During the match, Mendes brought down Ludovic Ajorque in the box for a penalty that Romain Del Castillo converted to give Brest the lead.
“Paris Saint-Germain doesn’t tolerate racism, antisemitism or any other form of discrimination,” the club said. “The racial insults directed at Nuno Mendes are totally unacceptable … we are working with the relevant authorities and associations to ensure those responsible are held accountable for their actions.”
MONTREAL – Tadej Pogacar was so dominant on Sunday, Canada’s Michael Woods called it a race for second.
Pogacar, a three-time Tour de France champion from Slovenia, pedalled to a resounding victory at the Grand Prix Cycliste de Montreal.
The UAE Team Emirates leader crossed the finish line 24 seconds ahead of Spain’s Pello Bilbao of Bahrain — Victorious to win the demanding 209.1-kilometre race on a sunny, 28 C day in Montreal. France’s Julian Alaphilippe of Soudal Quick-Step was third.
“He’s the greatest rider of all time, he’s a formidable opponent,” said Woods, who finished 45 seconds behind the leader in eighth. “If you’re not at your very, very best, then you can forget racing with him, and today was kind of representative of that.
“He’s at such a different level that if you follow him, it can be lights out.”
Pogacar slowed down before the last turn to celebrate with the crowd, high-five fans on Avenue du Parc and cruise past the finish line with his arms in the air after more than five hours on the bike.
The 25-year-old joined Belgium’s Greg Van Avermaet as the only multi-time winners in Montreal after claiming the race in 2022. He also redeemed a seventh-place finish at the Quebec City Grand Prix on Friday.
“I was disappointed, because I had such good legs that I didn’t do better than seventh,” Pogacar said. “To bounce back after seventh to victory here, it’s just an incredible feeling.”
It’s Pogacar’s latest win in a dominant year that includes victories at the Tour de France and Giro d’Italia.
Ottawa’s Woods (Israel Premier-Tech) tied a career-best in front of the home crowd in Montreal, but hoped for more after claiming a stage at the Spanish Vuelta two weeks ago.
“I wanted a better result,” the 37-year-old rider said. “My goal was a podium, but at the same time I’m happy with the performance. In bike racing, you can’t always get the result you want and I felt like I raced really well, I animated the race, I felt like I was up there.”
Pogacar completed the 17 climbs up and down Mount Royal near downtown in five hours 28 minutes 15 seconds.
He made his move with 23.3 kilometres to go, leaving the peloton in his dust as he pedalled into the lead — one he never relinquished.
Bilbao, Alaphilippe, Alex Aranburu (Movistar Team) and Bart Lemmen (Visma–Lease) chased in a group behind him, with Bilbao ultimately separating himself from the pack. But he never came close to catching Pogacar, who built a 35-second lead with one lap left to go.
“It was still a really hard race today, but the team was on point,” Pogacar said. “We did really how we planned, and the race situation was good for us. We make it hard in the last final laps, and they set me up for a (takeover) two laps to go, and it was all perfect.”
Ottawa’s Derek Gee, who placed ninth in this year’s Tour de France, finished 48th in Montreal, and called it a “hard day” in the heat.
“I think everyone knows when you see Tadej on the start line that it’s just going to be full gas,” Gee said.
Israel Premier-Tech teammate Hugo Houle of Sainte-Perpétue, Que., was 51st.
Houle said he heard Pogacar inform his teammates on the radio that he was ready to attack with two laps left in the race.
“I said then, well, clearly it’s over for me,” Houle said. “You see, cycling isn’t that complicated.”
Australia’s Michael Matthews won the Quebec City GP for a record third time on Friday, but did not finish in Montreal. The two races are the only North American events on the UCI World Tour.
Michael Leonard of Oakville, Ont., and Gil Gelders and Dries De Bondt of Belgium broke away from the peloton during the second lap. Leonard led the majority of the race before losing pace with 45 kilometres to go.
Only 89 of 169 riders from 24 teams — including the Canadian national team — completed the gruelling race that features 4,573 metres in total altitude.
Next up, the riders will head to the world championships in Zurich, Switzerland from Sept. 21 to 29.
Pogacar will try to join Eddy Merckx (1974) and Stephen Roche (1987) as the only men to win three major titles in a season — known as the Triple Crown.
“Today gave me a lot of confidence, motivation,” Pogacar said. “I think we are ready for world championships.”
This report by The Canadian Press was first published Sept. 15, 2024.
