When Hurricane Helene slammed into North Carolina in September 2024, it didn’t just knock out power and flood roads-it cut off the supply of intravenous fluids that hospitals across the U.S. rely on every single day. Within 72 hours, hospitals were rationing saline, postponing surgeries, and scrambling to find alternatives. This wasn’t an accident. It was a predictable failure in a system built on fragile, centralized manufacturing.
Why One Storm Can Shut Down a Nation’s Medicine Supply
The U.S. pharmaceutical industry doesn’t make drugs everywhere. It makes them in a handful of places. Puerto Rico alone used to produce 10% of all FDA-approved drugs and 40% of sterile injectables like saline, insulin, and antibiotics. After Hurricane Maria in 2017, the island’s power grid took 11 months to fully recover. Insulin shortages lasted 18 months. Patients went without. Hospitals had to choose who got treatment and who didn’t. Today, 65.7% of U.S. pharmaceutical manufacturing facilities sit in counties that have experienced at least one federally declared weather disaster between 2018 and 2023. Hurricanes are the biggest threat, causing 47% of all climate-related drug supply disruptions. But it’s not just hurricanes. Floods, wildfires, and even tornadoes have knocked out critical production lines. In 2023, a tornado hit Pfizer’s facility in Rocky Mount, North Carolina, and 27 different medicines vanished from shelves for months. What makes this worse? Most of these drugs have only one or two factories making them in the entire country. If that one factory goes down, there’s no backup. For sterile injectables-medicines you get through an IV-78% of them are produced at just one or two sites. No redundancy. No buffer. No plan.The Hidden Infrastructure Behind Your Medicine
It’s easy to think of drugs as just pills or vials. But behind every medicine is a chain of materials, machines, and power sources you never see. Take IV fluids. Baxter’s plant in North Cove, North Carolina, makes 1.5 million bags a day. That’s 60% of the U.S. supply. When Helene hit, the facility lost power, water pressure, and clean air filtration-all needed to keep sterile products safe. But even more hidden is what feeds the machines. In Spruce Pine, North Carolina, 90% of the world’s high-purity quartz comes from mines that supply semiconductor manufacturers. Those semiconductors? They’re inside the pumps, monitors, and automated packaging systems used in drug factories. No quartz? No sensors. No sensors? No automated production. No production? No medicine. This isn’t a story about hurricanes. It’s about how every part of the supply chain-from raw materials to shipping routes-is concentrated in areas that are now climate hotspots. And when one link breaks, the whole system fails.Why It Takes Years to Fix What a Storm Breaks
You can’t just build a new drug factory overnight. It takes 6 to 12 months just to get permits and start construction. Then comes the equipment. Specialized machines for sterile drug production cost millions and take 2 to 3 years to order, install, and certify. The FDA has to approve every step. And if the new facility is in a flood zone or hurricane path? You’re back to square one. The industry’s reliance on “just-in-time” inventory makes things worse. Instead of keeping extra stock, companies produce exactly what’s needed, when it’s needed. It saves money. But it leaves zero room for error. When a storm hits, there’s no shelf full of extra saline to pull from. There’s nothing. And patients pay the price.
Who Gets Left Behind
The worst impacts aren’t felt equally. Hospitals with 500 or more beds are 3.2 times more likely to have mapped their entire supply chain-knowing exactly which supplier makes which drug, where it’s made, and what the backup plan is. Small clinics? They don’t have the staff, the budget, or the tech to do that. When a shortage hits, they’re the last to know-and the first to run out. Cancer patients are especially vulnerable. Older generic injectables-like the drugs used in chemotherapy-are already in chronic shortage due to low profit margins. When a disaster hits, those drugs vanish first. The American Cancer Society found that during the 2024 IV fluid crisis, cancer centers delayed treatments because they couldn’t flush IV lines or deliver life-saving drugs safely. And it’s not just the U.S. The 2018 earthquake in Kermanshah, Iran, killed 700 people and injured 10,000. But because Iran’s drug production is more spread out, the medicine supply didn’t collapse. The U.S. system, by contrast, is a single point of failure waiting to break.What’s Being Done-And Why It’s Not Enough
Some progress is happening. The FDA now tracks climate disruptions as a leading cause of shortages. In 2025, they’re expected to require manufacturers of critical drugs to keep 90-day emergency stockpiles. That’s a start. The Strategic National Stockpile is testing pilot programs to store injectables in hurricane-prone regions. One pilot reduced shortage duration by 40% after Helene compared to Maria. AI is helping too. A company called Sensos.io used weather modeling to predict Helene’s impact 14 days in advance. Some hospitals used that warning to stockpile extra fluids. But only a few did. Most didn’t know the data existed-or how to use it. The problem? Solutions are patchy. Companies are doing climate risk assessments-but only 31% have actually acted on them. Regulatory changes move slowly. Emergency import routes, like the ones used after Maria, took 28 days to activate. In a crisis, that’s too long.
What Needs to Change
Experts agree: we need to stop treating drug supply chains like regular business logistics. This is public health infrastructure. And it needs to be built like a levee, not a sandcastle. First, we need geographic diversification. No single facility should produce more than 20% of a critical drug. Second, we need mandatory stockpiles for the most essential medicines-insulin, saline, antibiotics, anesthetics. Third, we need climate-resilient standards for all new manufacturing plants: elevated foundations, backup power, water filtration, and hardened supply routes. The cost? Experts estimate $12-15 billion over five years. That’s less than 1% of the U.S. pharmaceutical market. But the alternative? More patients dying because their IV line ran dry. More cancer treatments delayed. More surgeries canceled because the hospital ran out of saline. The climate isn’t coming. It’s already here. And it’s cutting off our medicine.What You Can Do
You can’t rebuild a drug factory. But you can demand change. Ask your doctor: “Is there a backup for this drug if a storm hits?” Contact your state representative: “Why aren’t we stockpiling life-saving medicines?” Support organizations pushing for supply chain reform. This isn’t about politics. It’s about survival. When the next storm comes, will we be ready-or will we just hope for the best?Why do drug shortages happen after natural disasters?
Drug shortages after natural disasters happen because the pharmaceutical supply chain is built around a few concentrated manufacturing sites. When a hurricane, flood, or wildfire damages one of these facilities, there’s often no backup. Many life-saving drugs are made in only one or two factories nationwide. If that factory loses power, water, or access to critical materials, production stops-and there’s no quick way to replace it.
Which drugs are most at risk during climate disasters?
Sterile injectables are the most vulnerable, including IV fluids like saline, antibiotics, insulin, anesthetics, and chemotherapy drugs. These require sterile conditions and specialized equipment to produce, making them hard to switch between factories. Older generic drugs are especially at risk because they have low profit margins, so manufacturers don’t invest in redundancy or backup systems. Insulin and saline shortages after Hurricane Maria lasted over a year, affecting millions of patients.
Why can’t we just make more drugs elsewhere?
Building a new pharmaceutical facility takes 6 to 12 months just to get approved and start construction. Then comes the equipment: specialized machines for sterile production cost millions and take 2 to 3 years to order and install. Even if you build a new plant, it must pass strict FDA inspections. Most new facilities are still located in climate-risk zones, so unless you relocate to a safer area and design for resilience, you’re just moving the problem.
Are drug shortages getting worse because of climate change?
Yes. Between 2017 and 2024, climate-related disruptions caused 32% of all U.S. drug shortages. The number of pharmaceutical facilities located in disaster-prone counties has increased, and climate models predict a 25-30% rise in Category 4-5 hurricanes by 2030. Events like Hurricane Helene in 2024 show that shortages are now happening faster and more frequently. Without major changes, experts predict climate-related shortages could increase by 150% by 2030.
What are hospitals doing to prepare for drug shortages?
Larger hospitals with 500+ beds are using AI tools and supply chain mapping to predict and track risks. Some are stockpiling emergency supplies, while others are working with regional health networks to share resources. But many smaller clinics lack the funding or staff to do this. Most hospitals still rely on last-minute fixes-like extending drug expiration dates-which can take 12-24 hours of pharmacy staff time per product, a burden during a crisis.
Is the government doing anything to fix this?
The FDA now recognizes climate disasters as a top cause of shortages and is developing new rules for 2025, including requiring manufacturers to maintain 90-day emergency stockpiles and submit climate risk plans. The Strategic National Stockpile is testing pilot programs to store critical injectables in safer regions. Congress passed the Strengthening America’s Supply Chain Act in 2022, but implementation is slow. Most changes are still in proposal form, and enforcement mechanisms are weak.
