How to alleviate the shortage: a scoping review of prevention and management of global drug shortages

Drug shortages have been reported to lead to insufficient treatment, delays or cancellations in care, poor medication adherence, prolonged hospital stays, increased medication errors, adverse events related to alternative therapies, and even deaths, posing a serious threat to public health. Despite ongoing and substantial efforts to address this issue, many drug shortages continue to persist. Against this backdrop, this study aims to conduct a scoping review of the mechanisms for preventing and managing global drug shortages, to offer insights and recommendations for countries seeking to resolve this pressing problem. Seven online literature databases were systematically searched, including PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Chinese biomedical literature database (CBM), China Science and Technology Journal Database (VIP), and Wanfang Database, from inception to October 2022. Supplementary searches were conducted using Bing and other public search engines. We included studies that discussed prevention, early warning, or response strategies for managing drug shortages in various countries. Thematic synthesis was used to analyze and categorize the extracted data on early warning and response measures. Our search strategy retrieved 7,821 references, of which 69 studies published between 2008 and 2022 met the inclusion criteria. The majority of included articles were reviews or systematic reviews (50 studies), providing comprehensive insights into drug shortage prevention, warning mechanisms, and response measures across different countries. Regarding preventive and early warning strategies, interventions at the production stage received significant attention, with regulatory recommendations focused on minimizing the risk of disruption. Regarding response strategies, the literature primarily addressed necessary actions at production, distribution, clinical use, and regulatory levels. This review underscores the urgent need for an integrated, cross-sectoral approach to drug shortage prevention and response. Strengthening connections across the pharmaceutical supply chain, refining stakeholder incentive structures, and leveraging technological innovations are essential for building systemic resilience. In practice, this calls for the establishment of international data-sharing agreements, investment in real-time monitoring infrastructure, and policy frameworks that balance regulatory oversight with market sustainability.