When Hurricane Helene tore through several southern states in the fall of 2024, its path of destruction was both immediate and far-reaching. Not only did the storm destroy homes and tragically claim more than 150 lives, but it also left an indelible mark on the nation’s healthcare system. According to Bloomberg, one of the country’s main factories producing intravenous (IV) fluid bags—essential tools in hospitals—was severely damaged. The aftermath? Manufacturer Baxter International Inc. was forced to ration supplies, and hospitals across the United States scrambled to stretch their dwindling stock of IV bags. This was not a one-off event, nor was it an isolated incident in the pharmaceutical world.
In fact, a groundbreaking new study led by the American Cancer Society and published in JAMA paints a stark picture of the vulnerabilities lurking within the U.S. drug supply chain. The research found that nearly two-thirds of all pharmaceutical-producing facilities in the United States from 2019 to 2024 were located in counties that experienced at least one weather disaster declaration. Hurricanes, floods, fires, storms, and tornadoes—no region or facility seemed immune to nature’s increasingly volatile temperament.
Researchers analyzed archived versions of the FDA’s Establishments Current Registration Site to identify every U.S.-based drug production facility active during this six-year period. They cross-referenced the locations with data from the Federal Emergency Management Agency (FEMA) on counties that received Presidential Disaster Declarations. The results were sobering: of the 10,861 drug production facilities reviewed, 6,819 (62.8%) were situated in counties hit by at least one weather disaster. On average, 2,146 active facilities (33.8%) each year were operating in areas under disaster declarations.
Dr. Leticia Nogueira, scientific director of health services research at the American Cancer Society and senior author of the study, didn’t mince words about the implications. “Drug shortages following weather disasters demonstrate how the pharmaceutical supply chain is not yet resilient to climate-related disruptions,” she explained in a statement released by the American Cancer Society. She underscored that a limited number of facilities often manufacture significant shares of key therapeutics, meaning that a single disaster can put countless patients at risk of treatment disruptions or delays.
Hurricanes emerged as the most common climate-related disaster affecting drug production facilities, but the study also documented the impact of floods, fires, storms, and tornadoes. The devastation wrought by Hurricane Helene in 2024 was just the latest example, echoing a similar crisis in 2017 when Hurricane Maria struck Puerto Rico. That storm, too, triggered a nationwide shortage of IV fluids, highlighting a recurring vulnerability in the drug supply chain.
Bloomberg’s reporting on the aftermath of Hurricane Helene brought the issue into sharp focus. With one of the main IV bag factories out of commission, Baxter International Inc. had no choice but to ration supplies. Hospitals, in turn, were forced to reduce their usage of IV bags, making tough decisions about which patients would receive the scarce resource. The event served as a real-world illustration of how climate change and extreme weather events can ripple through the healthcare system, sometimes in unexpected and dangerous ways.
It’s not just IV fluids that are at risk. The American Cancer Society pointed out that life-saving cancer drugs—especially older, generic sterile injectable drugs—have faced chronic shortages. While economic factors certainly play a role, climate-related disasters are increasingly contributing to 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,” said Mark E. Fleury, PhD, Principal, Policy Development – Emerging Science at the American Cancer Society Cancer Action Network.
The study’s findings pose a vexing challenge for policymakers and industry leaders. One might assume that simply relocating drug production facilities to safer areas would reduce the risk. However, the researchers found no statistically significant difference in the likelihood that counties with drug production facilities would experience a disaster declaration compared to those without such facilities. In other words, moving factories isn’t a viable long-term solution—disasters can strike almost anywhere.
“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 emphasized. She called for proactive measures to mitigate threats before they escalate into full-blown crises, warning that the stakes for patient care are simply too high to ignore.
Transparency, it turns out, is a recurring theme. Without clear visibility into where drugs are made and how supply chains are structured, it’s difficult for regulators, hospitals, or even manufacturers themselves to anticipate where the next shortage might occur. The American Cancer Society Cancer Action Network (ACS CAN), the advocacy arm of the ACS, is already working with lawmakers and federal agencies to address these systemic vulnerabilities. Their efforts include leading a drug shortage task force that brings together over 20 organizations to develop data-driven solutions.
“ACS CAN helps to lead a drug shortage task force that includes over 20 organizations working to create data-driven solutions to drug shortages,” Fleury said. The group’s goal is to ensure patients can access the medications they need without interruptions to their care, even in the face of mounting climate threats.
For patients and providers on the front lines, these vulnerabilities are far from abstract. Every shortage of a critical drug or medical supply can mean delayed treatments, altered care protocols, and, in some cases, life-threatening consequences. The situation after Hurricane Helene was a case in point—rationing IV bags forced hospitals to make difficult choices, and the risk of similar disruptions looms large as climate change continues to fuel more frequent and severe weather events.
As the nation grapples with these challenges, the message from researchers, advocates, and healthcare professionals is clear: building a resilient drug supply chain is not just a matter of logistics or economics. It’s a matter of public health and, quite literally, life and death. The next hurricane, flood, or wildfire could once again test the limits of the system. Whether those lessons are heeded—or ignored—will shape the future of healthcare in an increasingly unpredictable world.
