Drug shortages: A systems view of the current state

The objective of this thought leadership article is to create a systems view of drug shortages based on the perceptions of practitioners and policymakers. We develop a comprehensive framework describing what stakeholders are currently doing when faced with drug shortages and show the outcomes of their actions. In a review of practitioner literature and public reports published from 2010 to 2020, we identify cause-and-effect relationships related to generic drug shortages in six high-income European countries (Belgium, France, the Netherlands, Norway, Sweden, and the UK) in normal times. By combining and connecting data from these different sources, we develop a systems view of the current state. Though several of the associations covered in the systems view are well known, putting them all together and considering their interrelationships is what is offered by this research. Based on this systems view, we derive three basic solution archetypes for drug shortages: (1) let the market handle it; (2) search for alternatives; and (3) bend the rules. The interactions between these archetypes generate causal ambiguity making it harder to understand and solve the problem as the side effects of solutions can be missed. We show how the interaction of archetypes can compromise intended behavior or escalate unintended behavior. However, our systems view allows us to suggest higher-level solution archetypes that overrule such side effects. The basic and higher-order solution archetypes can provide baselines for research and support the development of future interventions.