Amid global conflict, Mark Samuels, chief executive of Medicines UK, warned earlier this month that Britain is “one step away” from medicines shortages if instability persists.
The complex nature of the medicines supply chain — from raw materials to manufacture and distribution — lends itself to issues and geopolitical factors only exacerbate these. Although the UK is not reliant on medicines manufactured in the Middle East or Iran, the closure of the Strait of Hormuz is disrupting logistics and freight, contributing to shortages of fuel and crucial components related to manufacturing globally.
These factors could put pressure on generic and biosimilar medicines manufacturers, ultimately triggering price rises for the NHS, supply shortages or both.
Crises often create the political momentum required to build structures and solutions that endure beyond immediate emergencies. While we are not quite yet at crisis point with medicines supply and shortages in the UK, resulting from the Iran conflict, the government should now “accept that medicine security is and should be treated as a national security issue”, as per recommendations from the House of Lords Public Service Committee inquiry into medicines security.
The overall timeline has been far too long for a critical patient safety issue, let alone one related to national security
According to a policy paper published by the Department of Health and Social Care (DHSC) in August 2025, government teams do “monitor and manage medicines supply at a national level and have a range of well-established systems and processes to proactively prevent disruptions where possible and effectively mitigate their impact on patients when they do occur”.
The policy paper further outlines the ongoing work and future plans to improve shortage management and strengthen medicines supply chain resilience.
However, 18 months on from ‘Medicines shortages: solutions for empty shelves’, the Royal Pharmaceutical Society (RPS) has warned that pharmacists continue to grapple with an “unsustainably high” number of medicines shortages. Published on 24 March 2026, its latest medicines shortages report recognises progress but highlights the need for “decisive steps”.
During the COVID-19 pandemic and in the face of subsequent medicine supply challenges, UK pharmacists were granted specific, temporary flexibilities to manage shortages by supplying alternative strengths or formulations without needing to contact the prescriber, facilitated by serious shortage protocols. However, it took until 18 September 2025 for the DHSC to launch a consultation to enable this to become a more permanent feature of pharmacy practice, allowing pharmacists greater professional judgement in managing ongoing supply issues.
It is still awaiting a decision that will hopefully result in formal change to legislation — the overall timeline has been far too long for a critical patient safety issue, let alone one related to national security. A decision is urgently needed now.
There is a need for longer-term investment in the diversification and streamlining of pharmaceutical supply chains, as well as developing the UK manufacturing infrastructure for medicines. The Life Sciences Innovation Manufacturing Fund, a capital grants fund aimed to build resilience for future health emergencies, now includes access for generic manufacturers, while four new NHS aseptic manufacturing sites will begin production by 2027. However, more work is needed here — while ‘reshoring’ may not be completely viable, surely exploring further options where sheltering a proportion of the supply that would provide a fail-safe in the event of a critical shortage should be prioritised.
Project Revive is an example of exactly how key stakeholders can and should be collaborating to mitigate the impact of shortages
Project Revive — a 12-month pilot announced in February 2026, involving the Medicines and Healthcare Products Regulatory Agency (MHRA), NHS England and Medicines UK — will offer fast-track regulatory advice on 378 dormant medicines that represent a serious risk to supply resilience. This is an example of exactly how key stakeholders can and should be collaborating to mitigate the impact of shortages.
Pharmacy teams have long needed access to trusted and reliable data on where medicines are in the overall UK supply chain to inform practice in times of shortage, a message echoed by an expert panel, including chief pharmacists, convened by The Pharmaceutical Journal in May 2023. Proactive data and information sharing is a legal and ethical responsibility across the supply chain and it is encouraging that the DHSC will publish an update to best practice guidance for ensuring the efficient supply and distribution of medicines across the supply chain later in 2026.
However, this information is desperately needed now, so further efforts in this area should be prioritised and expedited.
The impact of medicines shortages has been acknowledged and reported for years now. Insecurities in medicines supply are not something that patients or pharmacy teams can or should tolerate any longer. The government needs to take further swift and decisive steps to ensure medicines security, today, tomorrow and for years to come. PJ
