A Crisis Years in the Making
The United States is in the midst of a historic drug shortage crisis. As of late 2024, there were 277 active drug shortages, down only slightly from a record 323 the prior year. These shortages disproportionately affect critical medications such as sterile injectables, antibiotics, hormone therapies, chemotherapies, and intravenous fluids. The American College of Physicians (ACP) warns that the consequences are severe: patients are harmed when essential treatments are unavailable, physicians are forced to ration or scramble for alternatives, and health systems absorb significant operational strain.
Root causes are structural and multifaceted: outdated manufacturing infrastructure, reliance on offshore suppliers, economic incentives that favor low-cost generics over redundancy, and a lack of transparency across global supply chains. Natural disasters, pandemics, and geopolitical conflicts only magnify these vulnerabilities.
The Trump Administration’s Response: A New Executive Order
In August 2025, President Trump signed an executive order directing the Department of Health and Human Services’ Administration for Strategic Preparedness and Response (ASPR) to identify and stockpile active pharmaceutical ingredients (APIs) for approximately 26 essential medicines. The Strategic Active Pharmaceutical Ingredients Reserve (SAPIR), first created in 2020, is being refilled and expanded. The rationale is straightforward: APIs are cheaper to stockpile than finished drugs, they have longer shelf lives, and building a reserve would reduce dependence on foreign suppliers—particularly adversarial nations.
On the surface, this looks like a strong step toward pharmaceutical resilience. Stockpiling APIs may help buffer short-term disruptions, and government purchasing could stimulate domestic manufacturing capacity.
Policy Contradictions and Hollowed-Out Preparedness
Yet these measures stand in stark contradiction to broader policy shifts. At the same time the Administration is emphasizing stockpiling, it is weakening biomedical investments and rescinding Biden-era directives intended to reduce drug costs. It is also cutting funding for FEMA’s emergency response capabilities, state public health grants, and key agencies like ASPR, CDC, and NIH. These budget cuts undermine the very infrastructure needed to respond to and recover from drug shortages and health emergencies.
Massive cuts to biomedical research and development (R&D) further compound these vulnerabilities. Much of the progress in advanced manufacturing—such as continuous manufacturing, novel biologics platforms, and flexible vaccine and therapeutic production—has been seeded and sustained by federal investment through the NIH, BARDA, and other federal agencies. When that funding is massively reduced, the pipeline of innovation narrows, and the capacity to rapidly scale production of essential medicines in a crisis diminishes. Industry alone cannot reliably absorb the cost and risk of early-stage breakthroughs; public funding has historically underwritten these efforts, which later translate into lifesaving medical countermeasures.
The ACP and other professional bodies emphasize that sustainable solutions require long-term investment: innovative and modern manufacturing, diversifying global supply chains, and incentivizing reliable production—not just lowest-cost procurement. Without these systemic reforms, stockpiles risk becoming a Band-Aid on a much deeper wound.
Lessons from the Pandemic and Recent Shortages
The COVID-19 pandemic, and more recently the IV saline shortage, highlighted both vulnerabilities and solutions. Resilience requires more than reactive fixes—it requires proactive monitoring, surge capacity, and collaboration between government, manufacturers, and regulators. The National Academies stress that systemic supply chain risks—whether from cyberattacks, natural disasters, or geopolitical shocks—demand integrated strategies across sectors.
The FDA’s successful resolution of the saline shortage shows what’s possible: expanded manufacturing, regulatory flexibility, and coordinated response between federal agencies and industry. However, such successes are fragile if the institutions and funding that made them possible are hollowed out.
Why This Matters for Public Health Security
Drug shortages are not just a healthcare inconvenience—they are a national security concern. Patients in every community, from cancer patients awaiting chemotherapy to ERs needing IV fluids, are placed at risk when essential medicines vanish from the shelves. These shortages erode public trust in health systems and weaken America’s ability to respond to biological threats, pandemics, or mass-casualty events.
For the general public, the stakes are clear: resilient drug supply chains underpin the safety net of modern medicine. Without them, even routine healthcare can become life-threatening.
Moving Beyond Band-Aids
The U.S. cannot stockpile its way out of structural fragility. While the new executive order acknowledges the problem, it risks masking the larger truth: America’s pharmaceutical supply chain is only as strong as the weakest link in its manufacturing, regulatory, and funding ecosystem. True preparedness requires systemic investment, not piecemeal fixes paired with budget cuts.
If policymakers, healthcare professionals, and industry leaders are serious about health security, they must treat drug shortages not as isolated incidents, but as a sustained national emergency requiring coordinated, well-funded, and long-term solutions.
Sources and Further Reading
American College of Physicians: Bolstering the medication supply chain and ameliorating medication shortages
Becker’s Hospital Review: ACP urges action as drug shortages hit record highs
The Hill: Trump rescinds Biden-era order to lower drug costs
FiercePharma: Trump inks order to identify, stockpile key drug ingredients
Global Biodefense: NIH budget cuts threaten to cripple U.S. biomedical innovation and public health
Scientific American: Trump aims to cut program used to help hospitals evacuate during disasters