How Natural Disasters Cause Drug Shortages: Climate Risks to Your Medications

When a hurricane hits, it doesn’t just knock out power and flood homes-it can also cut off your life-saving medication. In 2017, Hurricane Maria destroyed power grids in Puerto Rico, where 10% of all FDA-approved drugs were made. Insulin, saline bags, and antibiotics vanished from hospital shelves. Some patients waited 18 months for supplies to return. That wasn’t an accident. It was a warning.

Why Your Medicine Vanishes After a Storm

Most people think drug shortages happen because of money, pricing, or manufacturing mistakes. But increasingly, they’re caused by weather. Between 2017 and 2024, nearly one-third of all U.S. drug shortages were linked to climate disasters, according to the FDA. Hurricanes, floods, and wildfires are now top causes-not just background risks.

The problem isn’t just the storm. It’s where drugs are made. Over 65% of U.S. pharmaceutical manufacturing facilities sit in counties hit by at least one major weather disaster between 2018 and 2023. Puerto Rico alone had 55 FDA-approved drug plants before Maria. One of them made 80% of the country’s insulin. When the power went out, it took 11 months to fix the grid. No electricity? No sterile production. No sterile production? No insulin for diabetics.

The IV Fluid Crisis: A Case Study in Fragility

In September 2024, Hurricane Helene slammed into North Carolina. It didn’t just damage buildings-it crippled Baxter International’s plant in North Cove. That one facility made 60% of the U.S. supply of IV fluids: the clear bags hung in hospital rooms for dehydration, chemotherapy, surgery, and emergency care.

Within 72 hours, hospitals nationwide started rationing. Elective surgeries were canceled. Cancer patients waited for fluids. Emergency rooms turned away non-critical cases. The FDA warned the shortage could last until mid-2025. Why? Because it takes 6 to 12 months to build a new sterile manufacturing line. You can’t just order more bags from China overnight. The machines that fill them are custom-built, expensive, and take years to install.

This isn’t the first time. After Hurricane Maria, saline shortages lasted 14 months. Hospitals had to reuse bags or dilute them dangerously. Nurses had to choose who got fluids and who didn’t. That’s not healthcare. That’s triage.

Why Concentration Is a Death Trap

The pharmaceutical industry loves efficiency. It’s cheaper to make drugs in one big plant than spread production across ten. But that efficiency is a vulnerability.

Seventy-eight percent of sterile injectable drugs in the U.S. have only one or two manufacturers. That means one tornado, one flood, one fire-and the entire country loses access. Take Spruce Pine, North Carolina. It’s not a drug factory. It’s a quartz mine. And 90% of the world’s high-purity quartz for medical devices comes from there. No quartz? No IV bags. No ventilators. No dialysis machines. The supply chain doesn’t just stop at the drug-it stops at the raw material.

Compare that to Iran’s 2018 earthquake. Over 700 died. Thousands were injured. But because Iran’s drug manufacturing was spread across dozens of smaller plants, shortages were minimal. The U.S. system is fragile because it’s centralized. And climate change is making storms stronger and more frequent.

What Types of Disasters Hit Drugs the Hardest

Not all disasters are equal when it comes to medicine.

- Hurricanes: Cause 47% of climate-related drug disruptions. They knock out power for weeks, flood factories, and destroy transportation routes. They hit broad categories-fluids, insulin, antibiotics-and last 6 to 18 months.

- Tornadoes: Account for 28% of disruptions. They’re faster but more focused. In 2023, a tornado hit Pfizer’s plant in Rocky Mount, North Carolina. Twenty-seven specific medicines vanished. Recovery took 3 to 9 months.

- Floods: Made up 19% of events. In 2022, flooding in Michigan hit Abbott’s infant formula plant. That worsened an already critical shortage, pushing families into panic for eight extra weeks.

- Wildfires and Heat: Less common, but growing. Smoke can contaminate drug batches. Extreme heat can degrade medications in storage or during transport.

The pattern is clear: the bigger the storm, the longer the shortage. And the more concentrated the manufacturing, the worse the impact.

What’s Being Done-and Why It’s Not Enough

Some solutions are emerging. After Hurricane Maria, the FDA created an emergency pathway to import drugs from overseas. But it took 28 days to approve saline from Europe. In a crisis, that’s too slow.

Now, the FDA is pushing a new rule: manufacturers of critical drugs must keep 90-day emergency stockpiles and submit climate risk plans by 2025. That’s a start. But only 31% of big drug companies have implemented real resilience strategies. The rest are still betting on luck.

Some hospitals are getting smarter. Mayo Clinic spent nine months mapping every supplier-from the raw chemical to the shipping truck. When a shortage hit, they found alternatives 65% faster. But most small hospitals can’t afford that kind of work.

AI is helping too. One company, Sensos.io, used weather models to predict Hurricane Helene’s impact on IV fluids 14 days in advance. A few hospitals used that warning to stockpile. Others didn’t. The difference? Lives.

Who Gets Left Behind

The system isn’t just broken-it’s unfair.

Hospitals with 500+ beds are over three times more likely to have supply chain maps than small clinics. That means rural hospitals, community health centers, and nursing homes are the last to know when a drug is running out. Cancer patients in Appalachia. Diabetics in the Gulf Coast. Elderly people in flood-prone towns-they’re not just inconvenienced. They’re put at risk.

And it’s not just about drugs. When IV fluids run out, so do chemotherapy drips. When insulin disappears, so does the ability to manage diabetes. When antibiotics are rationed, infections spread.

The American Society of Clinical Oncology warns that by 2027, cancer patients will face treatment delays during 8 to 10 major climate disasters every year-if nothing changes.

What Needs to Happen Next

There’s no magic fix. But here’s what’s needed:

• Geographic diversification: Make drugs in more places. Not just in hurricane zones. Not just in one state.
• Strategic stockpiles: The government needs to store critical drugs in secure, climate-resistant warehouses across the country-not just in one bunker.
• Faster approvals: The FDA needs to cut approval times for alternative suppliers during emergencies-from weeks to days.
• Investment in resilience: Experts say $12 to $15 billion spent now could prevent 70% of future shortages. That’s less than what the U.S. spends on antibiotics in a single year.

The cost of doing nothing? More deaths. More suffering. More hospitals forced to choose who lives and who doesn’t.

What You Can Do

You can’t build a new drug plant. But you can be prepared.

• If you take a critical drug-like insulin, heart medication, or chemotherapy-ask your pharmacist: Is there a backup source if this runs out?
• Keep a 30-day supply on hand if possible. Many insurers allow early refills during disaster warnings.
• Sign up for local emergency alerts. If a hurricane is coming, your drug supply might be next.
• Support policies that fund drug supply resilience. Contact your representative. Ask: Will my medication be safe when the next storm hits?

This isn’t about politics. It’s about survival. The next big storm is coming. And if we don’t fix this now, your next prescription might not be waiting on the shelf.