In Washington, just four miles from the U.S. Capitol, a children’s hospital is forced at times to call up nearby medical centers to see if they can spare the therapies needed for its young cancer patients.
In Chicago, a drug called epinephrine, which has multiple uses including maintaining blood pressure, can also fall into short supply, sometimes requiring the children’s hospital there to entirely rework its medication delivery protocols every few days.
These occurrences aren’t rare, hospital pharmacists say, and they carry a cost. Treatment in some cases may be delayed, and hospitals can too often find themselves recalibrating doses initially meant for adults, increasing the chance for errors. Now, 11 children’s hospitals are forming a new coalition aimed at blunting the effects of unstable supplies, turning to a company that grew out of the Covid-19 pandemic.
“Our staff, our teams, they’re always in a position of ‘Okay, this week we’ve got to keep our eye out to make sure we have a supply,’” said Kurt Newman, chief executive officer of Children’s National Hospital in Washington, D.C. “It’s not like you can easily take the adult version of that medication and modify it for use in children. That takes a lot of work.”
The Children’s Hospital Coalition officially kicked off its work on shortages last month. Early on, the group expects to focus on pain medications, sedatives, nutrition management and blood pressure maintenance.
Phlow Corp., based in Richmond, Virginia, was formed last year by a group of pharmaceutical executives. In May, it was awarded $354 million by the Trump administration to help produce Covid-19 treatments made in the U.S. The company’s new goal: Beginning the process of delivering needed therapies to the hospitals within a year, according to Eric Edwards, the company’s co-founder and chief executive officer.
Once the hospitals provide a list of drugs, the company will decide whether it will seek regulatory approval to produce some or all of the drugs itself or contract out the work, Edwards said. They’ll work through long-term purchasing agreements giving Phlow some financial stability that will allow the program to expand, he said.
The changes can’t come soon enough, hospital administrators said.
Drug shortages have been a problem no matter the age of patients for more than a decade, but the needs of children can be more precise than the needs of adults.
You can’t give an infant the same dose as a toddler or a 10-year-old, for instance. Errors can occur when changes happen regularly and patient care might have to be delayed until next week’s shipment arrives.
‘Down to Zero’
“We tend to have anywhere from five to seven days on hand of drugs at any given time,” said Eric Balmir, vice president and chief pharmacy officer at Children’s National. But with shortages, “that five to seven days can go down to two or one days, and when we get to that level, we are working furiously not to go down to zero.”
The hospital has a task force that meets weekly on the issue, according to Balmir, and there are times, he said, when he dials up nearby hospitals to ask if they have a certain drug to spare. “Sort of like the neighbor saying ‘I need a cup of sugar,’” Balmir said.
One chemotherapy currently in short supply is the only alternative available for about 10% of kids with the most common form of childhood cancer, acute lymphoblastic leukemia, said Douglas Hawkins, chairman of the Children’s Oncology Group, a cancer research organization.
A study published last year found that certain high-risk patients with this form of leukemia who couldn’t obtain the alternative had a 50% higher risk of a poor outcome, such as a relapse.
“We talk about progress in childhood cancer, but could you imagine a decrease in outcome because we can’t get a drug,” Hawkins said. “That’s kind of amazing in 2021.”
When Arkansas Children’s runs low on intravenous multivitamins, Kendrea Jones, director of pharmacy, prioritizes the newborns at her Little Rock hospital. Older babies and kids who need the nutritional boost may have to skip the vitamins every other day, she said, and some may weigh just enough to take adult vitamins instead.
In a report released last year, Vizient, a Texas-based health-care performance company, found children’s hospitals are disproportionately impacted by drug shortages, with a bigger percentage of them dealing with dwindling medicine stashes than other hospitals.
One of the hurdles that makes drug shortages such a struggle for pediatric hospitals is the pharmaceutical market itself.
The financial incentives aren’t strong enough to produce vast treatment options for children, which make up just a quarter of the U.S. population. If a pediatric formulation from one manufacturer comes up short, that may be enough to put children’s hospitals on alert.
Pediatric patients also rely heavily on injectable drugs, according to Jenny Elhadary, vice president of clinical services at the Ann & Robert H. Lurie Children’s Hospital in Chicago. “Depending on age, oral pills are just not an option, and many aren’t available in liquid form,” she said.
Sterile injectable drugs account for 63% of drug shortages, according to the FDA.
Hospital budgets are also another casualty of drug shortages. When pharmacies at children’s hospitals have to use small amounts of adult formulations to make drugs work for children, the rest of that vial they paid full price for might never get used.
“There are a lot of diseases or conditions that might be solvable with the right drug, but they’re not being made because the current companies aren’t doing it,” said Newman, with Children’s National. “Once we get through shortages, we want work with Phlow to tackle rare diseases.”