One in 13 Canadians, or an estimated 2.6 million people, suffers from a significant food allergy. Of those Canadians, about 630,000 of them carry an epinephrine auto-injector, a medication used in the event of a severe allergic reaction. Currently, only one brand of epinephrine auto-injector, the “EpiPen”, is available in Canada and its supply is rapidly diminishing. Health Canada issued a warning that the EpiPen manufacturer, Pfizer Canada, had advised them of its very limited supply of the adult 0.3 mg dose of auto-injectors due to a manufacturing issue. The 0.15 mg EpiPen auto-injectors designed for children (EpiPen Jr.) are still being supplied, however quantities are limited.
Explanations for these shortages are many and varied. They include the scarcity of raw ingredients, manufacturing glitches, stricter government regulation, and the discontinuation of products due to lack of profitability, to name a few. In the U. S. industry, greed has led to EpiPen prices skyrocketing to $600 for a twin pack of auto-injectors, whereas in Canada a single dose costs roughly $100.
Those with severe allergies are alarmed, and rightfully so. How would you feel if you went into your local pharmacy only to be told that your life saving medication is out of stock? It’s easy to blame Pfizer, but manufacturing problems truly do occur. With the supply running low across pharmacies across Canada, some people have resorted to Kijiji and Facebook marketplaces to find EpiPens.
At the moment, the Minister of Health has signed an order to allow an alternative to EpiPen (Auvi-Q epinephrine auto-injectors) to be imported to Canada. The federal government has also urged pharmacists to ration sales of EpiPens to one per person, and to hang on to expired products and only sell them if necessary. Research conducted by a team at the University of California, San Diego, has shown that EpiPens are effective for up to four years after they’ve expired so long as the product’s colour remains clear. If the colour has turned brownish-yellow, then it’s likely that the EpiPen will no longer work.
As the EpiPen shortage worsens, the public is questioning why Canada relies solely on one pharmaceutical manufacturer to supply a life-saving treatment used by many across the country. A potential explanation is that EpiPens are currently made at a single Pfizer facility in St. Louis Missouri. And according to Dr. Amir Attaran of the University of Ottawa, shortages continue to occur because there is no requirement for the facility to maintain a continuous supply. The problem may even drag into the upcoming year with no clear solution in sight.
In order to resolve this problem, there should be a stronger focus on building stronger communication between drug companies and health authorities in order to navigate market fluctuations together. Furthermore, the federal government should take measures to ensure that pharmaceutical manufacturers provide a consistent supply of medication. If the government will not impose these strict policies and demand a consistent supply, they should at least entice other pharmaceutical companies to enter the market and distribute their auto-injectors. Having only one provider puts the lives of Canadians at risk.
Recently, Health Canada authorized many other companies including Kaleo Pharma, Lincoln Medical, Taro Pharmaceuticals, and Bausch Health Companies to sell similar epinephrine auto-injectors. The problem? These products have not yet entered the Canadian market. To overcome this issue, the New Democratic party has even suggested expropriating patents. This means that Canadian companies could be given permission to copy patented drugs controlled by U.S. companies, like the EpiPen. As promising as a solution like this might be, it will resolve nothing if a Canadian based supply chain is not made readily available.
It’s not clear how many people actually have life-threatening allergic reactions from exposure to foods, drugs, animals, pollen, dust, and any other sources. Approximately 7.5% of Canadians have some sort of food allergy, and approximately one percent of all emergency department visits are for an allergic reaction. Fortunately, deaths from anaphylaxis are not common, with only about 15 anaphylaxis-related deaths occurring per year in Canada. Despite this, all 15 of these deaths are preventable, and we should do all that we can to ensure that those who need EpiPens have access to them whenever and wherever they are needed.