It’s a scenario that’s become all too familiar for doctors, pharmacists, and patients across the United States: a hurricane barrels through, and suddenly, life-saving intravenous (IV) fluids are in short supply from coast to coast. In 2024, Hurricane Helene slammed into North Carolina, damaging a critical pharmaceutical facility and triggering a nationwide shortage of IV fluids. It was a déjà vu moment for many healthcare professionals, who remembered the similar chaos caused by Hurricane Maria’s landfall in Puerto Rico back in 2017. Both storms exposed a hidden vulnerability in America’s drug supply chain—one that’s now been laid bare by a sweeping new study from the American Cancer Society (ACS), published in the Journal of the American Medical Association (JAMA) on August 21, 2025.
The study’s findings are as startling as they are urgent. According to ACS researchers, nearly two-thirds—precisely 62.8%—of all pharmaceutical-producing facilities in the United States were located in counties that experienced at least one weather disaster declaration between 2019 and 2024. That’s not just a statistical quirk; it’s a systemic exposure to risk, with hurricanes, wildfires, storms, tornadoes, and floods all threatening the backbone of America’s drug production network. As the study’s senior author, Dr. Leticia Nogueira, scientific director of health services research at the ACS, put it: “Drug shortages following weather disasters demonstrate how the pharmaceutical supply chain is not yet resilient to climate-related disruptions.”
To reach these conclusions, researchers took a thorough approach. They pored over archived versions of the U.S. Food and Drug Administration’s (FDA) Establishments Current Registration Site, identifying every domestic drug production facility active from 2019 to 2024. The numbers are staggering: 10,861 facilities in total, with annual counts ranging from 5,063 in 2023 to 8,790 in 2020. On average, about 2,146 facilities—roughly 33.8%—were active each year in counties that faced at least one weather disaster declaration during the study period. Hurricanes, the study found, were the most common climate-driven disaster impacting these counties, but wildfires, storms, tornadoes, and floods also posed significant threats.
Why does this matter so much? The answer lies in the structure of the drug supply chain itself. Many essential medications, including older generic sterile injectable drugs, are produced by a limited number of facilities. If just one or two are knocked offline by a disaster, the ripple effects can be felt nationwide. “A limited number of facilities may manufacture significant shares of key therapeutics,” Dr. Nogueira explained. “This could put many people in need of lifesaving drug treatment at risk of disruptions or delays in care.”
What’s more, the study’s authors discovered that simply relocating drug manufacturing plants isn’t a viable solution. Their analysis revealed no statistically significant difference in disaster likelihood between counties with and without drug production facilities. In other words, there’s nowhere to hide—climate-related disasters are striking broadly and unpredictably. As the researchers noted, “counties without drug production plants had about the same average risk of a weather disaster declaration as those now home to such a plant.”
This finding upends a common assumption in supply chain management: that risk can be mitigated by moving operations to ‘safer’ locations. Instead, the study argues for a different approach—one that emphasizes transparency, redundancy, and proactive disaster risk management across the entire pharmaceutical supply chain. “These findings underscore the importance of recognizing climate-related vulnerabilities and the urgent need for supply chain transparency that allows integration of disaster risk management strategies into strategic resource allocation throughout the pharmaceutical supply chain,” Dr. Nogueira said. “Moving forward, threats must be examined and proactively mitigated to prevent critical health care disruptions.”
The consequences of these disruptions are not theoretical. When Hurricane Maria devastated Puerto Rico in 2017, it wasn’t just the island that suffered. Puerto Rico is a major hub for pharmaceutical manufacturing, and the storm’s impact reverberated across the entire U.S. healthcare system. IV fluid shortages forced hospitals to ration supplies, delay treatments, and scramble for alternatives. Fast forward to 2024, and Hurricane Helene’s impact on North Carolina echoed those same problems—once again, a single weather event led to a nationwide crisis in drug availability.
Mark E. Fleury, Ph.D., Principal for Policy Development—Emerging Science at the American Cancer Society Cancer Action Network (ACS CAN), highlighted the chronic nature of these shortages. “Life-saving cancer drugs, especially older generic sterile injectable drugs, have been in chronic shortages due to a combination of factors, including economic reasons and climate-related disasters,” he said. Fleury emphasized the need for a more resilient system: “The American Cancer Society Cancer Action Network (ACS CAN), ACS’s advocacy affiliate, has been working with lawmakers and federal agencies to address systemic vulnerabilities and create a more resilient system to ensure patients can access the medications they need without disruptions to their care.”
ACS CAN is not working alone. The organization helps lead a drug shortage task force that includes over 20 organizations, all striving to develop data-driven solutions to these persistent supply problems. Their efforts focus on increasing transparency in the supply chain, promoting redundancy in manufacturing, and integrating disaster risk management into every stage of drug production and distribution. As Fleury put it, “This study illustrates the need for redundancy in the drug supply chain.”
Beyond the immediate headlines, the ACS study signals a broader reckoning for the pharmaceutical industry and policymakers alike. Climate change is no longer a distant threat—it’s a present-day disruptor, reshaping the risk landscape for critical infrastructure, including healthcare. The call to action is clear: it’s time to move beyond reactive crisis management and invest in long-term resilience.
For patients, the stakes couldn’t be higher. When drug shortages hit, it’s not just an inconvenience—it can mean delays in chemotherapy, missed doses of antibiotics, or rationed anesthesia in emergency rooms. For healthcare providers, these shortages create ethical dilemmas and logistical nightmares. And for policymakers, the message from the ACS and its partners is unambiguous: proactive, coordinated action is needed now to safeguard the nation’s drug supply against the growing threat of climate-driven disasters.
The ACS, with its long history of advocacy, research, and patient support, is throwing its weight behind this cause. As the organization continues to work with lawmakers, federal agencies, and industry partners, the hope is that the lessons of Hurricane Maria and Hurricane Helene will not be forgotten. Instead, they can serve as a catalyst for building a drug supply chain that’s robust, transparent, and prepared for whatever the next storm may bring.
With climate change accelerating and weather disasters becoming more frequent and severe, the ACS study is a wake-up call for the entire healthcare ecosystem. The time for resilience isn’t tomorrow—it’s right now.
