OnCo
ideasIdea

A strategic reserve of essential generic cancer drugs to end recurring shortages

Cancer patients have had treatments delayed because basic chemotherapy drugs ran out. Keeping a national stockpile, like for flu antivirals, would prevent this.

Shortages of cisplatin, carboplatin, methotrexate, fluorouracil and other essential generics recur every few years in high-income countries and chronically in LMICs, usually after a single manufacturer's quality failure. Several countries hold strategic reserves of antivirals and antibiotics; none holds oncology essentials. The proposal is a rotating national or regional reserve covering six months of demand for the 20 most shortage-prone oncology generics, with stock rotated through normal supply chains to avoid waste, procurement rules that require dual sourcing, and automatic release triggers.

Hypothesis
Reserves eliminate treatment delays and dose modifications attributed to shortages of covered drugs and reduce shortage-related switching to inferior regimens to near zero.
Rationale
The drugs are cheap and stable, the shortage cost (delayed curative treatment) is very high, and the reserve approach has worked for other essential medicines; the barrier is only that no one has been made responsible.
What would test it
Establish a reserve for ten drugs in one country and compare shortage-related treatment delays with the prior three years and with peer countries.
Maturity
early clinical
Who has to act
policy
Cost to try
Medium ($1M to $50M)
Years to first evidence
2
Bottlenecks it attacks

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