Puerto Rico’s healthcare supply chain reacts to Hurricane Fiona


As Hurricane Fiona hit Puerto Rico late Sunday night, inundating the archipelago and blacking out its battered power grid, healthcare industry leaders and government agencies braced for impact.

The Category 1 storm placed the island in an ongoing state of emergency. All of Puerto Rico’s 3.1 million residents lost power. Another 60% of residents lost access to clean water. The Port of San Juan was temporarily closed to merchant ships on Monday and travel advisories have been issued restricting the movement of local residents while the damage is assessed. It was another blow to a US territory beset by failing infrastructure from overexposure to severe weather.

Five years ago – almost to the day – Hurricane Maria devastated Puerto Rico, killing 3,000 people and severely crippling its infrastructure. healthcare providers in the United States struggling with delays in medical equipment and pharmaceuticals as local manufacturers recover from the rubble.

Hurricane Maria hit medical device manufacturer Baxter International particularly hard. Puerto Rican facilities were largely responsible for manufacturing small-volume IV bags, while large-volume bags were manufactured on the mainland. Hospitals resorted to the larger bags to deliver medicines to patients, increasing demand for the product. Baxter’s fourth-quarter revenue fell $70 million due to production disruptions following the 2017 storm.

Today, Puerto Rico’s manufacturers of medical devices and pharmaceutical products, which account for more than half of the territory’s exports, are in a better position.

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Pharmaceutical and medical device manufacturers have learned lessons from Hurricane Maria and invested in backup generators, fuel, community services, food and water to help them meet operational challenges. Some companies have started to spread their manufacturing facilities across the country to build broader resilience to regional climate disasters.

Puerto Rico has been home to the manufacturing of medical devices and pharmaceuticals for half a century. Multinational companies operate 52 Food and Drug Administration-approved pharmaceutical plants in the territory. The island, about the size of Connecticut, also includes nearly 70 medical device manufacturers that develop pacemakers, surgical instruments, laboratory equipment and other essential products, according to data from the Puerto Rico Department of Economic Development and Commerce.

The FDA said it is “actively monitoring” the situation on the island. The American Hospital Association said it is awaiting damage assessments from the Health and Human Services Department and the Federal Emergency Management Agency to understand what impact the storm could have on broader industrial operations.

A shortage of medicines and medical devices could lead to delayed interventions, fewer treatment options and higher costs. But amid flooding and a power outage, many businesses are saying their Puerto Rican locations are operational.

Most of Baxter’s Caribbean facilities were back online Tuesday thanks to generator power and fuel supplies, but their ability to be fully operational depends on accessibility of local roads and bridges. For now, Baxter has “healthy inventory levels for most products manufactured in Puerto Rico and the Dominican Republic for U.S. customers,” according to a company statement.

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Pharmaceutical company Amgen said measures taken ahead of the storm helped ensure its flagship site in Juncos, Puerto Rico, would continue operations.

“Before the storm, we activated our well-rehearsed business continuity plans, which included proactively switching power to the site to generators. We have enough generator capacity and fuel to support ongoing operations,” said a spokesman for Amgen, which also has smaller manufacturing facilities in the US, Ireland, the Netherlands and Singapore.

With the island devastated, Amgen said it is reaching out to the 2,400 employees who work at its largest manufacturing facility and offering assistance.

Abbott planned the destruction in advance by sending employees home with disaster relief kits and food. It also distributed supplies to an oncology department at a local children’s hospital. None of Abbott’s facilities were damaged during the hurricane, a spokesman said.

The medical device and drug maker has invested in food banks, community health clinics and infrastructure like generators, wireless hotspots and cold storage to prepare for long-term emergencies.

The device manufacturer Boston Scientific has also stocked up on generators, water and chainsaws for its employees. Brad Sorenson, executive vice president of global supply chain, said the company’s manufacturing facility in Dorado, Puerto Rico, was converted to independent water and power systems before the hurricane hit. The plant can operate on backup supply for up to two months, he said.

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“We went offline 36 hours before the hurricane made landfall and powered ourselves,” Sorenson said. “We do it on our timeline. We don’t sit and wait for the lights to go out.”

Before the storm, Boston Scientific executives ensured product availability and adequate inventory levels, and sent employees home for two days while the storm took its toll. Nearly 90% of their employees were at work Wednesday, Sorenson said. The plant is operated at peak capacity to compensate for losses.

“It’s going to take a couple of weeks, but we’ll be able to make up for the two days that we’ve been proactively shutting down,” Sorenson said.

After Hurricane Fiona, the American Society of Health-System Pharmacists expressed concern about the lack of transparency in the pharmaceutical industry. Michael Ganio, the trade group’s senior director of pharmacy practice and quality, wrote in an email that their main concern was the lack of transparency from drugmakers about manufacturing locations and production volumes.

“Having this information up front will help organizations prepare for potential bottlenecks and prevent mitigation strategies like hoarding that can create additional disruptions,” Ganio added.



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