Drug Shortages, Supply Resilience, and Access to Essential Medicines in the United States: A Narrative Review
Rinre Wachap
*
Department of Political Science, University of Rhode Island, Rhode Island, USA.
Olukunle O. Akanbi
Department of Psychology and Behavioral Sciences, National Louis University, Florida, USA.
Felix Donkor
Department of Physical Sciences, Eastern New Mexico University–Portales, New Mexico, USA.
Antonio Selorm Heheatror
Department of Physical Sciences, Eastern New Mexico University–Portales, New Mexico, USA.
*Author to whom correspondence should be addressed.
Abstract
Persistent drug shortages remain a major challenge for the United States healthcare system because they can compromise timely access to clinically important medicines, continuity of care, patient safety, and health-system resilience. This narrative review synthesises peer-reviewed evidence and current U.S. regulatory and policy sources identified through targeted searches of PubMed-indexed records, publisher platforms, and authoritative institutional sources, with searches updated through July 30, 2026. The review examines interacting structural, economic, regulatory, governance, and access-related determinants rather than treating shortages as isolated production failures. The evidence indicates that manufacturing concentration, limited production redundancy, fragile economics in some mature generic markets, upstream dependencies, quality-related disruptions, demand shocks, and procurement incentives can combine to increase supply vulnerability. The consequences of a disruption depend not only on aggregate supply but also on the availability of substitutes and the capacity of healthcare organisations to adapt without compromising care. Direct evidence of systematic disparities across institutions and patient groups remains incomplete; accordingly, equity concerns are treated as an important but still under-measured dimension of shortage response. On the basis of the synthesis, this review proposes an author-developed conceptual framework organised around six continuous functions—Prevent, Detect, Coordinate, Protect Access, Recover, and Learn—supported by transparency, accountability, incentive alignment, and equity. The framework is intended to organise policy responsibilities and evaluation questions rather than to represent a validated causal model. Drug-shortage policy should therefore combine prevention, early warning, coordinated response, resilience-oriented incentives, accountable governance, and explicit protection of clinically appropriate access.
Keywords: Drug shortages, essential medicines, pharmaceutical supply chain, health policy, governance, supply-chain resilience, medicine access, health equity