Corona-Arias, C. A., Corona González, R. D., Martínez Salto, A. S., Paredes Ydiaquez, M. M., Vergara Trujillo, R. A.,
Castañeda López, E. Y., Guardiola Segovia, S., & Mercado Estrada, E. G.
1033
e-ISSN
3073-1151
July-September
, 2025
Vol.
2
, Issue
3
,
1033-1049
https://doi.org/10.63415/saga.v2i3.265
Multidisciplinary Scientific Journal
https://revistasaga.org/
Original Research Article
Global Medicine Shortages: Public Health
Challenges and Policy Responses
Escasez mundial de medicamentos: Desafíos para la salud pública
y respuestas de política
Carlos Alberto Corona-Arias
1
, Ricardo Daniel Corona González
2
,
Amy Scarlet Martínez Salto
3
, Manuel Maximiliano Paredes Ydiaquez
4
,
Richard Adrian Vergara Trujillo
5
, Estefany Yetlanetzi Castañeda López
6
,
Sebastian Guardiola Segovia
7
, Erwin Giovanny Mercado Estrada
8
1
Universidad Industrial de Santander, Bogotá, Colombia
2
Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Pachuca, México
3
Universidad Veracruzana, Veracruz, México
4
Universidad César Vallejo, Trujillo, Perú
5
Institución Davita, Cali, Colombia
6
Universidad Autónoma de Nayarit, Nayarit, México
7
Universidad Autónoma de Coahuila, Coahuila, México
8
Universidad Autónoma Metropolitana, Unidad Xochimilco, Ciudad de México, México
Received
: 2025-08-29 /
Accepted
: 2025-09-28 /
Published
: 2025-09-30
ABSTRACT
Medicine shortages have emerged as a persistent global health challenge, affecting both high-income and low- and
middle-income countries. This study analyzed the prevalence, duration, recurrence, systemic drivers, and coping
strategies associated with shortages in Mexico, Colombia, and Peru, situating the findings within the international context.
Using a cross-sectional design with 1,250 participants, results revealed that shortages were most frequent among
antimicrobials, oncology agents, insulin, and anesthetics. These shortages not only lasted longer and recurred more often
than in other therapeutic categories but also disproportionately affected low-income and rural populations. Coping
strategies included therapeutic substitution and private purchasing, but also riskier responses such as resorting to informal
markets and treatment abandonment. Participants identified manufacturing failures, import dependence, and procurement
weaknesses as the main systemic drivers, consistent with international evidence. The findings highlight that medicine
shortages are not isolated events but structural failures embedded within fragile pharmaceutical systems. Addressing them
requires proactive, resilient, and equity-focused policies, including early warning systems, resilient procurement models,
diversification of supply chains, and targeted protections for vulnerable populations.
keywords
: medicine shortages; public health; pharmaceutical policy; Latin America; health equity
RESUMEN
El desabasto de medicamentos se ha consolidado como un desafío persistente de salud global, afectando tanto a países de
altos ingresos como a países de ingresos bajos y medios. Este estudio analizó la prevalencia, duración, recurrencia, causas
sistémicas y estrategias de afrontamiento relacionadas con los desabastos en México, Colombia y Perú, enmarcando los
hallazgos en el contexto internacional. Mediante un diseño transversal con 1,250 participantes, los resultados mostraron
que los desabastos fueron más frecuentes en antibióticos, medicamentos oncológicos, insulinas y anestésicos. Estos
desabastos no solo duraron más tiempo y se repitieron con mayor frecuencia que en otras categorías terapéuticas, sino
que también afectaron de manera desproporcionada a poblaciones de bajos ingresos y zonas rurales. Las estrategias de
afrontamiento incluyeron la sustitución terapéutica y la compra privada, pero también respuestas más riesgosas como
recurrir al mercado informal o abandonar el tratamiento. Los participantes identificaron fallas de manufactura,
dependencia de importaciones y debilidades en la adquisición como las principales causas sistémicas, en concordancia
con la evidencia internacional. Los hallazgos subrayan que los desabastos no son eventos aislados, sino fallas estructurales
insertas en sistemas farmacéuticos frágiles. Abordarlos requiere políticas proactivas, resilientes y centradas en la equidad,
SAGA Multidisciplinary Scientific Journal | e-ISSN 3073-1151 | July-September, 2025 | vol. 2 | issue 3 | p. 1033-1049
Corona-Arias, C. A., Corona González, R. D., Martínez Salto, A. S., Paredes Ydiaquez, M. M., Vergara Trujillo, R. A.,
Castañeda López, E. Y., Guardiola Segovia, S., & Mercado Estrada, E. G.
1034
que incluyan sistemas de alerta temprana, modelos de adquisición resilientes, diversificación de cadenas de suministro y
protección dirigida a poblaciones vulnerables.
Palabras clave:
desabasto de medicamentos; salud pública; política farmacéutica; América Latina; equidad en salud
RESUMO
A escassez de medicamentos consolidou-se como um desafio persistente para a saúde global, afetando tanto países de alta
renda quanto países de baixa e média renda. Este estudo analisou a prevalência, duração, recorrência, causas sistêmicas e
estratégias de enfrentamento relacionadas às faltas no México, Colômbia e Peru, enquadrando os achados no contexto
internacional. Por meio de um delineamento transversal com 1.250 participantes, os resultados mostraram que as faltas
foram mais frequentes em antibióticos, medicamentos oncológicos, insulinas e anestésicos. Essas faltas não apenas
duraram mais tempo e se repetiram com maior frequência do que em outras categorias terapêuticas, mas também afetaram
de maneira desproporcional populações de baixa renda e áreas rurais. As estratégias de enfrentamento incluíram a
substituição terapêutica e a compra privada, mas também respostas mais arriscadas, como recorrer ao mercado informal
ou abandonar o tratamento. Os participantes identificaram falhas de fabricação, dependência de importações e fragilidades
na aquisição como as principais causas sistêmicas, em consonância com a evidência internacional. Os achados destacam
que as faltas não são eventos isolados, mas falhas estruturais inseridas em sistemas farmacêuticos frágeis. Enfrentá-las
requer políticas proativas, resilientes e centradas na equidade, que incluam sistemas de alerta precoce, modelos de
aquisição resilientes, diversificação das cadeias de suprimento e proteção direcionada a populações vulneráveis.
palavras-chave
: escassez de medicamentos; saúde pública; política farmacêutica; América Latina; equidade em saúde
Suggested citation format (APA):
Corona-Arias, C. A., Corona González, R. D., Martínez Salto, A. S., Paredes Ydiaquez, M. M., Vergara Trujillo, R. A., Castañeda López, E. Y.,
Guardiola Segovia, S., & Mercado Estrada, E. G. (2025). Global Medicine Shortages: Public Health Challenges and Policy Responses. Multidisciplinary
Scientific Journal SAGA, 2(3), 1033-1049.
https://doi.org/10.63415/saga.v2i3.265
This work is licensed under an international
Creative Commons Attribution-NonCommercial 4.0 license
INTRODUCTION
Medicine shortages represent one of the
most critical and persistent challenges facing
global health systems today. Once perceived as
episodic events triggered by isolated
manufacturing or distribution failures,
shortages are now recognized as systemic
phenomena with profound implications for
patient safety, clinical outcomes, and the
sustainability of healthcare delivery worldwide
(Acosta et al., 2019; Shukar et al., 2021). Over
the last decade, the scale and complexity of
shortages have increased significantly,
particularly for essential medicines that form
the backbone of therapeutic care. Recent
evidence highlights recurrent disruptions
affecting oncology drugs, antibiotics, insulins,
anesthetics, and pediatric formulations, many
of which are included on the World Health
Organization’s Model List of
Essential
Medicines (Postma et al., 2022; Pandey et al.,
2024; Rosário et al., 2024; World Health
Organization, 2023).
The global relevance of this problem has
been reinforced by multiple converging
signals. In high-income countries, such as the
United States and members of the European
Union, official drug shortage registers have
documented unprecedented numbers of active
shortages between 2022 and 2024, despite
extensive regulatory oversight (Bochenek et
al., 2018; Ravela et al., 2022). In the OECD,
shortages are no longer confined to niche or
low-demand products but increasingly affect
high-volume generics and critical hospital
injectables, disrupting standard treatment
protocols (Lopert et al., 2022). Meanwhile,
LMICs, including those in Latin America,
experience compounded challenges due to
dependence on imports, fragmented supply
chains, and weaker procurement and
surveillance systems (Gómez-Dantés et al.,
2022; López & Sánchez, 2023; Vargas, 2022).
Scholarly work has shed light on multiple
dimensions of this crisis. Bate, Lind, and
Mathur (2023) demonstrated, using
procurement data, that global patterns of
shortages align with structural fragilities in
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Castañeda López, E. Y., Guardiola Segovia, S., & Mercado Estrada, E. G.
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supply chains and the geographic
concentration of active pharmaceutical
ingredient (API) production in Asia. Yaroson
et al. (2024) emphasized the importance of
medicines shortages reporting systems
(MSRS) as tools for early detection, noting that
only a minority of countries have robust,
publicly accessible systems. Kanan et al.
(2025) conducted a systematic review showing
how shortages impact patient outcomes
through therapeutic substitution, treatment
delays, and increased costs. In parallel, Limb
(2025) and Baraniuk (2024) underscored how
shortages now constitute a systemic threat to
health security, prompting governments to
reconsider resilience criteria in procurement
contracts.
Latin America provides a particularly
important lens through which to examine this
issue. In Mexico, repeated shortages of
oncology and chronic disease medicines have
triggered both social mobilization and policy
reforms, yet the problem persists (Gómez-
Dantés et al., 2022). In Colombia, national
authorities have institutionalized
“desabastecimiento” alerts, though response
capacity is uneven across regions and
therapeutic categories (Das et al., 2023). Peru,
despite recent legislative measures requiring
pharmacies to stock essential generics,
continues to report recurrent disruptions in
antibiotic and pediatric formulations (López &
Sánchez, 2023). These national experiences
exemplify the broader structural dependencies
of LMICs on international markets, where six
out of every ten medicines are imported
(Vargas, 2022).
The policy discourse has also evolved
considerably. Caviglioli et al. (2025) proposed
algorithms to systematize therapeutic
alternatives during shortages, while
Santhireswaran et al. (2025) reviewed the
impact of supply chain disruptions on
prescribing trends, showing how clinicians
adapt by shifting toward second-line therapies.
Das et al. (2023) further highlighted the
inequitable burden of shortages in cancer care
across Latin America, where treatment
interruptions translate directly into worsened
survival outcomes. OECD reports (Lopert et
al., 2022) and WHO analyses (World Health
Organization, 2023) converge on the need for
integrated strategies that combine regulatory
foresight, manufacturing resilience, and
international cooperation.
Despite the increasing scholarly and policy
attention, critical knowledge gaps remain.
Much of the existing literature focuses on high-
income countries, while evidence from Latin
America and other LMICs remains sparse.
Furthermore, although prior work has
identified supply chain fragilities, less
attention has been given to comparative
analyses across multiple middle-income
settings, where the interplay between
procurement practices, manufacturing
dependency, and policy responses shapes
unique national experiences (Bate et al., 2023;
López & Sánchez, 2023). Addressing these
gaps is vital, as the region represents a
significant share of the global population and
is particularly vulnerable to systemic supply
shocks.
In this context, the present study seeks to
contribute by analyzing medicine shortages in
three Latin American countries
—
Mexico,
Colombia, and Peru
—
within the broader
global landscape. Specifically, we aim to
identify the therapeutic classes most affected,
the structural drivers of recurrent shortages,
and the policy mechanisms that have been
mobilized or proposed to mitigate their impact.
The guiding research questions are: (1) Which
therapeutic classes and patient groups are most
impacted by shortages in these countries? (2)
What structural and systemic factors underlie
recurrent shortages in their health systems?
and (3) Which policy interventions offer
feasible and sustainable solutions to enhance
supply chain resilience? These questions are
derived directly from the literature and align
with international policy frameworks
developed by organizations such as the OECD,
WHO, and World Bank (Vargas, 2022; Lopert
et al., 2022; World Health Organization,
2023).
By grounding this inquiry in both global
and regional perspectives, the study aligns its
design with theoretical and empirical insights
from prior work while contributing novel
comparative evidence from Latin America.
Ultimately, the analysis not only enhances
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Castañeda López, E. Y., Guardiola Segovia, S., & Mercado Estrada, E. G.
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understanding of global medicine shortages
but also provides a policy-relevant roadmap
for strengthening resilience in contexts that
remain disproportionately affected by these
systemic disruptions.
METHODS
Participants
The study was conducted with a total of
1,250 participants across three Latin American
countries: Mexico (n = 500), Colombia (n =
400), and Peru (n = 350). Recruitment was
designed to capture a diverse population of
medicine users, reflecting a broad range of
demographic and socioeconomic
characteristics.
-
Inclusion criteria required participants to:
1. Be at least 18 years of age.
2. Have sought, purchased, or used at
least one prescribed medication within the past
12 months.
3. Provide informed participation through
verbal or written consent.
-
Exclusion criteria were:
1. Participants under 18 years.
2. Incomplete or inconsistent responses
during the survey.
3. Health professionals directly involved
in procurement or distribution, to avoid
conflicts of interest and biased responses.
Demographic profile:
-
Gender: 54% female, 46% male.
-
Age: Mean = 39.4 years (SD = 12.6; range
18
–
72).
-
Educational attainment: 42% higher
education, 35% secondary education, 23%
primary or less.
-
Socioeconomic level: stratified by national
income quintiles
—
28% low-income, 49%
middle-income, 23% high-income.
-
Ethnic composition: 65% mestizo, 21%
Indigenous, 9% Afro-descendant, 5%
other.
This diversity was critical for examining
how medicine shortages may
disproportionately affect vulnerable groups,
such as Indigenous populations in rural areas
and low-income households with limited
access to private health facilities (Gómez-
Dantés et al., 2022; López & Sánchez, 2023).
Sampling Procedure
A stratified multistage sampling design was
applied to ensure representativeness across
both urban and rural areas.
1. Stage 1: Each country was divided into
strata based on major urban centers and rural
regions. For Mexico, data were collected in
Mexico City, Guadalajara, Monterrey, and two
rural municipalities; for Colombia, Bogotá,
Medellín, Cali, and rural areas of Cauca and
Meta; for Peru, Lima, Arequipa, Trujillo, and
two rural provinces in the Andean highlands.
2. Stage 2: Within each stratum,
healthcare facilities, pharmacies, and
community health centers were randomly
selected.
3. Stage 3: Participants were recruited
proportionally to the population served by each
facility or community network.
The sample size of 1,250 was calculated
using a 95% confidence interval and a 3%
margin of error, based on an estimated
prevalence of shortages at 50% (to maximize
sample size). This calculation ensured
sufficient statistical power for cross-country
and subgroup comparisons (Bochenek et al.,
2018; Ravela et al., 2022).
Data Collection Instruments and
Procedures
Data collection employed a structured
questionnaire, designed and validated through
expert consultation and adapted from prior
international surveys on medicine access and
shortages (Bate et al., 2023; Yaroson et al.,
2024; Kanan et al., 2025).
Questionnaire structure:
1. Section A
–
Demographics: Age,
gender, ethnicity, socioeconomic level,
education, insurance status.
2. Section B
–
Access and Availability:
Types of medicines sought in the last 12
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months, frequency of shortages, duration of
stock-outs, recurrence of shortages within the
same year.
3. Section C
–
Causes of Shortages:
Participants’ perceptions of contributing
factors, including manufacturing problems,
procurement practices, distribution
bottlenecks, and regulatory barriers.
4. Section D
–
Coping Strategies: Actions
taken when medicines were unavailable, such
as therapeutic substitution, purchasing in
private pharmacies, use of informal markets, or
delaying treatment.
The questionnaire underwent a pilot test
with 50 participants (distributed equally across
the three countries) to ensure clarity and
cultural appropriateness. Feedback led to
minor modifications in wording. Reliability
analysis yielded a Cronbach’s alpha of 0.87,
indicating strong internal consistency.
Data collection process:
-
Mode: 70% face-to-face interviews in
health facilities and community
pharmacies, 30% via online surveys for
participants in remote areas.
-
Training: Data collectors received
standardized training to ensure consistency
in administering the questionnaire and
handling participant inquiries.
-
Quality control: Supervisors conducted
random audits of 10% of questionnaires to
verify completeness and accuracy.
-
Variables and Operational Definitions
-
Shortage occurrence (dependent variable):
Defined as self-reported inability to obtain
a prescribed medicine within 48 hours of
seeking it from a licensed pharmacy or
healthcare facility.
-
Duration of shortage: Number of
consecutive days a medicine remained
unavailable, as reported by participants.
-
Therapeutic class: Categorized by WHO’s
Anatomical Therapeutic Chemical (ATC)
classification (e.g., antibacterials,
antineoplastics, insulins, anesthetics).
-
Socioeconomic status (SES): Classified
using self-reported monthly household
income relative to national poverty lines
and education level.
-
Coping strategy: Recorded as categorical
responses (substitution, out-of-pocket
private purchase, informal market, delay,
or abandonment of treatment).
Research Design
This study employed a cross-sectional, non-
experimental design, appropriate for assessing
prevalence and associated factors of medicine
shortages in multiple national contexts. By
combining patient-reported experiences with
contextual information from pharmacies and
health facilities, the design enabled
triangulation of findings and cross-country
comparability.
This design aligns with previous global
investigations that treat shortages as structural
health system phenomena rather than isolated
logistical disruptions (Acosta et al., 2019;
Shukar et al., 2021; Limb, 2025). Cross-
sectional surveys have proven effective in
describing shortage patterns and generating
evidence for policy recommendations in
OECD and LMIC settings (Lopert et al., 2022;
World Health Organization, 2023).
Ethical Considerations
The study followed international ethical
standards for health research. Participation was
voluntary, with informed consent obtained
from all participants. No personal identifiers
were collected, and data confidentiality was
assured. Local institutional approvals were
obtained in each country through academic and
health-sector partners, consistent with national
regulations.
RESULTS
In this section, we present the main findings
of the study regarding the prevalence, duration,
and recurrence of medicine shortages across
Mexico, Colombia, and Peru. Results are
reported using descriptive statistics and
grouped according to therapeutic classes,
demographic characteristics, and systemic
drivers identified in the survey. The analysis
focuses on aggregated patterns rather than
individual-level data, highlighting the most
critical trends that inform subsequent
interpretation.
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Corona-Arias, C. A., Corona González, R. D., Martínez Salto, A. S., Paredes Ydiaquez, M. M., Vergara Trujillo, R. A.,
Castañeda López, E. Y., Guardiola Segovia, S., & Mercado Estrada, E. G.
1038
Overall, shortages were observed across a
wide range of therapeutic categories, with
notable concentration in antimicrobials,
oncology agents, insulin and related
antidiabetic drugs, and anesthetics. Duration of
shortages varied significantly across countries
and drug classes, with some medicines
experiencing repeated disruptions within the
same fiscal year. In addition, socioeconomic
disparities were evident, with low-income
participants and rural communities reporting
greater difficulty in accessing essential
medicines compared to urban and higher-
income groups.
The presentation of results follows a
structured approach. Each figure summarizes a
specific aspect of the findings
—
prevalence
rates, therapeutic categories, shortage duration,
coping strategies, and systemic drivers.
Figures are accompanied by detailed
descriptions to ensure clarity and
reproducibility. The aim is to provide a
comprehensive overview of the data in a
format that supports later discussion and policy
analysis.
Figure 1
. Prevalence of Medicine Shortages by Therapeutic Class
Figure 1 illustrates the prevalence of
medicine shortages across therapeutic classes
reported by participants in Mexico, Colombia,
and Peru. The results show that antimicrobials
(62%) were the most frequently affected
category, followed by oncology agents (55%),
insulin and other antidiabetic drugs (48%), and
anesthetics (44%). Cardiovascular drugs
(37%), central nervous system (CNS)
medicines (32%), and pediatric formulations
(29%) were also significantly impacted, albeit
at lower levels.
The prominence of antimicrobial shortages
reflects a global concern consistent with prior
studies showing recurrent disruptions in the
availability of antibiotics, particularly beta-
lactams and pediatric formulations (Pandey et
al., 2024; Shukar et al., 2021). Such shortages
are especially critical in LMICs, where
infectious diseases remain a leading cause of
morbidity. Similarly, the high prevalence of
oncology drug shortages aligns with
international reports indicating that injectable
chemotherapies and supportive care agents are
among the most vulnerable classes due to
complex manufacturing processes and limited
suppliers (Das et al., 2023; Limb, 2025).
The shortage of insulins and antidiabetic
medicines highlights an urgent public health
challenge in the region, given the rising
prevalence of diabetes in Latin America.
Previous analyses have documented the
systemic fragility of insulin supply chains,
heavily reliant on a few multinational
producers (Gómez-Dantés et al., 2022; WHO,
2023). Anesthetic shortages, meanwhile,
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mirror reports from OECD countries where
sedatives and analgesics have faced recurrent
disruptions due to procurement practices and
fragile supply redundancies (Lopert et al.,
2022; Ravela et al., 2022).
Although cardiovascular and CNS
medicines ranked slightly lower in prevalence,
their shortages remain clinically significant, as
they affect large populations requiring long-
term, uninterrupted treatment. Finally,
pediatric formulations are disproportionately
affected compared to adult formulations,
echoing previous findings that low commercial
incentives and smaller batch sizes exacerbate
vulnerability (Rosário et al., 2024; Caviglioli
et al., 2025).
Taken together, these findings confirm that
shortages are not evenly distributed but are
concentrated in critical therapeutic areas with
high public health importance. This pattern is
consistent with both global monitoring and
prior regional studies in Latin America,
underscoring the need for targeted
interventions to protect essential medicines in
these categories (Acosta et al., 2019; López &
Sánchez, 2023; World Health Organization,
2023).
Figure 2
. Average Duration of Medicine Shortages by Therapeutic Class
Figure 2 illustrates the average duration of
medicine shortages across therapeutic classes.
The results indicate that oncology agents
experienced the longest shortages, with an
average duration of 36 days, followed by
insulin and other antidiabetic medicines (28
days) and anesthetics (24 days). Shortages of
antimicrobials and CNS medicines lasted on
average 18 and 20 days respectively, while
cardiovascular drugs and pediatric
formulations reported comparatively shorter
interruptions, averaging 15 and 12 days.
The extended shortages observed in
oncology drugs are consistent with
international evidence. Several studies
emphasize that injectable chemotherapies and
supportive care agents face recurrent
disruptions due to complex manufacturing
requirements, limited suppliers, and fragile
market incentives (Das et al., 2023; Lopert et
al., 2022). These prolonged disruptions are
particularly concerning given that delays in
cancer treatment can directly compromise
survival outcomes.
Similarly, the shortage duration of insulins
and antidiabetic medicines reflects global
supply chain vulnerabilities. Insulin
production is concentrated among a few
multinational companies, and distribution
often depends on cold chain logistics, which
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increases the risk of prolonged gaps (Gómez-
Dantés et al., 2022; WHO, 2023). The
relatively long shortages of anesthetics
correspond with OECD and LMIC reports
documenting recurrent scarcities in sedatives
and analgesics, largely attributed to
procurement practices and a lack of
redundancy in sterile injectable production
(Ravela et al., 2022; Limb, 2025).
By contrast, pediatric formulations and
cardiovascular drugs displayed shorter average
durations, likely due to the availability of
alternative therapeutic options and the
presence of generic competition. However,
even shorter shortages in these categories can
disrupt continuity of care, particularly in
vulnerable populations such as children and
patients with chronic cardiovascular disease
(Rosário et al., 2024; Caviglioli et al., 2025).
Overall, the data confirm that shortage
duration is not uniform but varies significantly
across therapeutic classes, with the most
critical impact observed in oncology and
chronic disease medicines. These findings
reinforce previous global observations that
duration and recurrence of shortages are
greatest in medicines with complex
manufacturing processes, limited supplier
bases, or high logistic demands (Acosta et al.,
2019; Bate et al., 2023; Shukar et al., 2021).
Figure 3
. Recurrence of Medicine Shortages Within the Same Year
Figure 3 depicts the recurrence of medicine
shortages within the same year across
therapeutic classes. The highest recurrence
was observed in oncology agents (51%),
followed by insulin and antidiabetic medicines
(47%) and antimicrobials (42%). In contrast,
recurrence rates were lower for anesthetics
(38%), CNS medicines (33%), cardiovascular
drugs (29%), and pediatric formulations
(26%).
The particularly high recurrence among
oncology drugs reflects the structural fragility
of supply chains for sterile injectables, where a
limited number of global producers dominate
the market. Previous studies have shown that
cancer treatments are highly vulnerable to
repeated shortages due to manufacturing
quality issues and a lack of alternative
suppliers (Das et al., 2023; Lopert et al., 2022).
Recurrence in oncology is especially
concerning because repeated disruptions can
delay multiple treatment cycles, compounding
negative outcomes for patients.
The recurrence of shortages in insulins
similarly mirrors global experiences. Given the
chronic nature of diabetes management,
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interruptions
—
even temporary ones
—
tend to
resurface within short intervals. The reliance
on a small number of multinational
manufacturers, combined with the logistic
demands of cold chain distribution, creates
conditions for cyclical disruptions (Gómez-
Dantés et al., 2022; WHO, 2023).
For antimicrobials, recurrent shortages are
closely linked to volatility in demand and
limited profitability of generic antibiotics.
Studies have shown that narrow profit margins
reduce incentives for continuous production,
increasing the likelihood of repeated gaps in
supply (Pandey et al., 2024; Shukar et al.,
2021).
While recurrence was somewhat lower in
cardiovascular, CNS, and pediatric
formulations, the figures still represent a
significant systemic weakness. Even at lower
rates, repeated shortages in these categories
can compromise long-term management of
chronic conditions or essential pediatric
treatments, especially in low-resource settings
(Rosário et al., 2024; Caviglioli et al., 2025).
Overall, the data confirm that recurrence of
shortages is not an isolated phenomenon but a
structural feature, particularly pronounced in
oncology, insulin, and antibiotics. This aligns
with international literature showing that
medicines with complex manufacturing, high
global demand, and limited redundancy are
most susceptible to repeated disruptions
(Acosta et al., 2019; Bate et al., 2023; Limb,
2025).
Figure 4
. Coping Strategies Reported by Participants During Medicine Shortages
Figure 4 presents the coping strategies
adopted by participants when facing medicine
shortages. The most frequent strategy was
therapeutic substitution (46%), followed by
purchasing medicines from private pharmacies
(38%). Less common but still significant
responses included delaying treatment
initiation (27%), resorting to the informal
market (14%), and abandoning treatment
altogether (9%).
The predominance of therapeutic
substitution reflects practices observed
globally, where physicians and pharmacists
adapt treatment protocols to mitigate shortages
by prescribing alternative agents within the
same therapeutic class. While substitution can
ensure continuity of care, it may compromise
efficacy or increase the risk of adverse
outcomes if alternatives are less optimal
(Caviglioli et al., 2025; Shukar et al., 2021).
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Purchasing from private pharmacies
underscores the financial burden imposed by
shortages. Prior studies in Latin America have
documented that out-of-pocket spending rises
significantly when patients are forced to
procure medicines outside public facilities,
often exacerbating socioeconomic inequities
(Gómez-Dantés et al., 2022; López & Sánchez,
2023).
The delay of treatment
—
reported by over
one-quarter of participants
—
poses substantial
risks, particularly for chronic diseases and
oncology care. International evidence shows
that treatment interruptions, even for brief
periods, can negatively affect clinical
outcomes and survival rates in cancer and
diabetes patients (Das et al., 2023; WHO,
2023).
The use of informal markets and treatment
abandonment are the most alarming responses.
Resorting to unregulated channels increases
the likelihood of exposure to falsified or
substandard medicines, a threat repeatedly
highlighted by the WHO in the context of
shortages (World Health Organization, 2023).
Abandoning treatment, though less frequent,
remains a critical concern because it indicates
a complete breakdown of access and continuity
of care.
Overall, the coping strategies observed
mirror global findings: while substitution and
private purchase are common, shortages also
drive patients toward unsafe or harmful
behaviors, magnifying health risks and
inequities (Acosta et al., 2019; Limb, 2025;
Bate et al., 2023).
Figure 5
. Reported Systemic Drivers of Medicine Shortages
Figure 5 presents the systemic drivers of
medicine shortages as reported by participants.
The most frequently cited factor was
manufacturing and quality failures (52%),
followed by dependence on imports (47%) and
procurement and pricing issues (41%). Less
frequently mentioned but still relevant were
distribution and logistics delays (33%) and
regulatory barriers (29%).
The prominence of manufacturing and
quality failures aligns with international
literature documenting how disruptions in
production plants
—
particularly sterile
injectables
—
trigger widespread shortages
(Das et al., 2023; Lopert et al., 2022). Recalls
due to quality concerns or the shutdown of a
single plant can have cascading effects across
multiple countries, especially when limited
redundancy exists in supply chains (Acosta et
al., 2019).
Dependence on imports was also
recognized as a major vulnerability. Latin
America, including Mexico, Colombia, and
Peru, imports a significant proportion of its
active pharmaceutical ingredients (APIs) and
finished medicines, with Asia (India and
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1043
China) as the dominant suppliers (Vargas,
2022; Gómez-Dantés et al., 2022). This
dependence exposes countries to external
shocks such as export restrictions, supply
bottlenecks, or geopolitical tensions (World
Health Organization, 2023).
Procurement and pricing issues were
frequently identified, consistent with previous
findings that single-supplier tenders and
lowest-price procurement models reduce
resilience. When suppliers exit markets due to
thin margins, supply continuity becomes
jeopardized (Bate et al., 2023; Shukar et al.,
2021).
Distribution and logistics delays, although
reported less frequently, remain critical,
particularly in rural and geographically
isolated regions. Natural disasters, port
congestion, and limited cold chain
infrastructure exacerbate these vulnerabilities
(Ravela et al., 2022; Limb, 2025).
Finally, regulatory barriers were noted as a
contributing factor. Complex or slow
regulatory processes for importation and
marketing authorization can delay alternative
sourcing, even when shortages are well-
documented. International organizations such
as the EMA and WHO have recommended
regulatory flexibilities during crises to mitigate
these delays (Caviglioli et al., 2025; World
Health Organization, 2023).
Together, these findings highlight those
shortages are not caused by a single point of
failure but rather by the intersection of multiple
systemic drivers. The pattern observed in Latin
America reflects global trends, reinforcing the
need for integrated solutions that address
manufacturing resilience, procurement reform,
and regulatory agility.
Figure 6
. Prevalence of Medicine Shortages by Socioeconomic Group
Figure 6 shows the prevalence of medicine
shortages stratified by socioeconomic group.
The results indicate that participants from low-
income households reported the highest
prevalence (61%), followed by those in the
middle-income group (44%), while high-
income participants reported substantially
fewer shortages (28%).
These findings highlight the well-
documented inequities in access to medicines,
particularly in Latin America, where
socioeconomic disparities strongly determine
health outcomes. Previous research has shown
that households with lower income depend
more heavily on public health facilities and
government procurement systems, which are
often the most affected by shortages (Gómez-
Dantés et al., 2022; López & Sánchez, 2023).
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In contrast, high-income groups have greater
flexibility to mitigate shortages by purchasing
medicines in private pharmacies or accessing
imported alternatives, thus buffering the
impact (Acosta et al., 2019; Bate et al., 2023).
The intermediate prevalence observed in
middle-income households reflects their dual
reliance on public provision and out-of-pocket
purchases. While they have more capacity than
low-income groups to turn to private channels,
financial constraints still limit their options
when prices surge during shortages (Shukar et
al., 2021; Limb, 2025).
These inequities reinforce the argument that
medicine shortages disproportionately harm
vulnerable populations. The WHO (2023) has
stressed that shortages exacerbate health
inequities by forcing patients with fewer
resources to delay or abandon treatment, while
wealthier groups can absorb costs. This
dynamic perpetuates cycles of inequality in
health outcomes across socioeconomic strata.
Overall, the data emphasize the intersection
of shortages and social determinants of health,
underscoring the need for targeted policies that
protect access for disadvantaged groups.
Without structural reforms, shortages risk
widening existing inequities in healthcare
systems across Latin America.
Figure 7
. Prevalence of Medicine Shortages by Setting (Urban vs. Rural)
Figure 7 compares the prevalence of
medicine shortages between urban and rural
settings. The results demonstrate that 58% of
rural participants reported shortages, compared
with 39% of urban participants, highlighting a
significant geographic disparity in access to
medicines.
This urban
–
rural divide is consistent with
prior literature showing that rural communities
often experience disproportionate barriers to
healthcare access. Geographic isolation,
limited distribution infrastructure, and fewer
healthcare facilities exacerbate the
vulnerability of rural populations to shortages
(Acosta et al., 2019; López & Sánchez, 2023).
Moreover, rural pharmacies and clinics
typically rely on centralized procurement and
distribution systems, which are more
susceptible to delays and stock-outs during
supply chain disruptions (Ravela et al., 2022;
Bate et al., 2023).
Urban participants, although still affected
by shortages, reported a comparatively lower
prevalence due to the greater availability of
private pharmacies, larger hospital networks,
and alternative supply channels. This aligns
with findings from OECD and WHO reports,
which note that urban populations are better
positioned to mitigate shortages through
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diversified access points (Lopert et al., 2022;
World Health Organization, 2023).
The disparity also underscores the
intersection between territorial inequities and
socioeconomic vulnerabilities. Rural
communities frequently overlap with lower-
income groups and Indigenous populations,
making them doubly exposed to shortages and
their consequences (Gómez-Dantés et al.,
2022; Das et al., 2023). In these contexts,
treatment delays or abandonment become
more likely, further widening health inequities.
In summary, the data confirm that medicine
shortages disproportionately affect rural
populations, reflecting systemic inequities in
distribution and healthcare infrastructure.
These findings reinforce the need for targeted
policies aimed at strengthening rural supply
chains, ensuring redundancy, and improving
last-mile distribution in Latin America and
beyond (Shukar et al., 2021; Limb, 2025).
DISCUSSION
The findings of this study confirm that
medicine shortages constitute a systemic and
multidimensional challenge for health systems
in Latin America, consistent with global
patterns documented across both high-income
and low- and middle-income countries. The
analysis revealed that shortages
disproportionately affect therapeutic classes of
high public health relevance, persist for
extended durations, recur within the same year,
and exacerbate inequities by
disproportionately impacting low-income and
rural populations. These results are aligned
with and extend prior research, offering new
comparative evidence from Mexico,
Colombia, and Peru.
Shortages by Therapeutic Class
The concentration of shortages in
antimicrobials, oncology agents, insulin, and
anesthetics (Figures 1
–
3) reflects a global
trend. Antimicrobial shortages have been
repeatedly reported worldwide, with recurrent
disruptions in beta-lactams and pediatric
formulations, undermining infectious disease
management (Pandey et al., 2024; Shukar et
al., 2021). Oncology drug shortages have been
particularly persistent due to complex
manufacturing processes and limited supplier
redundancy, consistent with findings from
OECD countries and international reviews
(Das et al., 2023; Lopert et al., 2022).
Similarly, insulin shortages are emblematic of
fragile global supply chains, dominated by a
few multinational companies and requiring
specialized cold chain logistics (Gómez-
Dantés et al., 2022; World Health
Organization, 2023). Anesthetic shortages,
though less frequently studied, have been
reported in both high-income and LMIC
settings, often linked to procurement practices
and sterile injectable fragilities (Ravela et al.,
2022; Limb, 2025).
The relatively lower prevalence in
cardiovascular, CNS, and pediatric medicines
should not obscure their clinical importance.
Even temporary shortages in these areas
disrupt continuity of care for chronic
conditions and vulnerable populations,
echoing prior warnings about the inequitable
burden of shortages on pediatrics (Rosário et
al., 2024; Caviglioli et al., 2025). These
findings confirm that shortages are not evenly
distributed but cluster around medicines with
the greatest clinical and logistical
vulnerabilities, consistent with previous
studies (Acosta et al., 2019; Bate et al., 2023).
Duration and Recurrence
The results also demonstrate that shortages
in oncology, insulin, and antimicrobials last
longer and recur more often than in other
categories (Figures 2
–
3). This aligns with
reports showing that shortages of sterile
injectables and essential chronic disease
medicines tend to persist over weeks or months
and often resurface within the same fiscal year
(Bochenek et al., 2018; Ravela et al., 2022).
Such recurrence is not incidental but reflects
systemic features of fragile supply chains. As
highlighted by OECD and WHO analyses, the
combination of concentrated production,
limited profit margins, and lack of redundancy
perpetuates cyclical shortages in essential
therapeutic classes (Lopert et al., 2022; World
Health Organization, 2023).
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Coping Strategies and Risks
Coping strategies reported by participants
reveal both adaptive and risky behaviors
(Figure 4). Therapeutic substitution and
private purchases are consistent with global
patterns, where physicians and patients seek
alternatives to maintain continuity of care
(Caviglioli et al., 2025; Shukar et al., 2021).
However, the reliance on private markets
increases out-of-pocket expenditure,
reinforcing socioeconomic inequities, a
concern repeatedly documented in Latin
America (Gómez-Dantés et al., 2022; López &
Sánchez, 2023). More alarming are the use of
informal markets and treatment abandonment,
which expose patients to falsified or
substandard products, a risk highlighted by
WHO reports on falsification during shortages
(World Health Organization, 2023). These
findings echo prior analyses showing that
shortages not only disrupt care but can also
actively generate public health risks by
pushing patients toward unsafe coping
mechanisms (Limb, 2025; Acosta et al., 2019).
Systemic Drivers
Participants identified manufacturing
failures, dependence on imports, and
procurement issues as the most significant
drivers of shortages (Figure 5). These
perceptions align with empirical evidence.
Bate, Lind, and Mathur (2023) demonstrated
that procurement dynamics and concentrated
supply chains amplify shortages globally.
Manufacturing fragilities, particularly in
sterile injectables, have been well documented
(Das et al., 2023; Lopert et al., 2022), and
dependency on imports remains a defining
vulnerability of Latin American health systems
(Vargas, 2022; Gómez-Dantés et al., 2022).
Procurement models focused on lowest-price
tenders, without resilience criteria, have also
been criticized for discouraging market
competition and reducing supply redundancy
(Shukar et al., 2021; Yaroson et al., 2024).
Finally, regulatory barriers
—
though less
prominent
—
have been repeatedly cited in the
literature as slowing emergency imports or
therapeutic alternatives, reinforcing the need
for flexible regulatory responses (Caviglioli et
al., 2025; World Health Organization, 2023).
Socioeconomic and Territorial Inequities
The findings in Figures 6 and 7 highlight
how shortages magnify pre-existing health
inequities. Low-income participants reported
the highest prevalence of shortages, consistent
with evidence that disadvantaged groups are
most reliant on public supply chains and least
able to absorb the financial burden of private
purchases (Gómez-Dantés et al., 2022; López
& Sánchez, 2023). This inequitable burden has
been described as a systemic injustice, where
shortages widen disparities in treatment
adherence and outcomes (Acosta et al., 2019;
Limb, 2025).
Similarly, rural participants reported
significantly more shortages than urban
participants, a finding supported by prior
studies documenting geographic disparities in
access to medicines (Ravela et al., 2022; Bate
et al., 2023). Rural areas face greater logistical
challenges, fewer pharmacies, and weaker
healthcare infrastructure, leaving populations
doubly exposed when shortages occur. As
WHO (2023) and OECD (Lopert et al., 2022)
emphasize, such inequities threaten health
equity and require targeted interventions in
supply chain distribution and rural
infrastructure.
Implications for Policy and Research
Taken together, these results reinforce that
medicine shortages are not episodic anomalies
but systemic risks embedded in the global
pharmaceutical supply chain. The convergence
of our findings with international literature
(Acosta et al., 2019; Shukar et al., 2021; Bate
et al., 2023; Yaroson et al., 2024; Kanan et al.,
2025; Pandey et al., 2024; Rosário et al., 2024;
Limb, 2025; Baraniuk, 2024; Santhireswaran
et al., 2025; Caviglioli et al., 2025; Gómez-
Dantés et al., 2022; López & Sánchez, 2023;
Vargas, 2022; Bochenek et al., 2018; Das et al.,
2023; Lopert et al., 2022; Ravela et al., 2022;
World Health Organization, 2023) underscores
the robustness of the evidence base.
Importantly, this study adds comparative
insights from three middle-income Latin
American countries, a region where shortages
remain under-documented but highly
consequential.
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1047
The policy implications are clear:
governments must adopt integrated strategies
that go beyond reactive measures.
Recommended approaches include the
development of early warning systems, the
inclusion of resilience criteria in procurement
contracts, diversification of supply sources,
investment in local production, and regulatory
flexibility during crises. Furthermore, targeted
interventions are needed to protect
disadvantaged populations and rural
communities, ensuring that shortages do not
deepen health inequities.
CONCLUSION
This study provides a comprehensive
analysis of medicine shortages in Mexico,
Colombia, and Peru, situating the findings
within the broader international context. The
results demonstrate that shortages are
systemic, recurrent, and inequitable,
disproportionately affecting essential
therapeutic classes, persisting for extended
durations, and imposing heavier burdens on
low-income and rural populations.
The evidence confirms that antimicrobials,
oncology agents, insulin, and anesthetics are
the most vulnerable categories, consistent with
global patterns identified in both high-income
and low- and middle-income countries (Acosta
et al., 2019; Shukar et al., 2021; Pandey et al.,
2024; Rosário et al., 2024). Shortages in these
classes lasted longer and recurred more
frequently, reflecting structural fragilities in
global supply chains, concentrated production,
and insufficient redundancy (Bochenek et al.,
2018; Lopert et al., 2022; Ravela et al., 2022).
The coping strategies employed by patients,
including therapeutic substitution and private
purchasing, reveal both resilience and inequity.
While substitution can maintain continuity of
care, reliance on private pharmacies amplifies
financial burdens, particularly for
disadvantaged groups (Gómez-Dantés et al.,
2022; López & Sánchez, 2023). More
concerning strategies, such as reliance on
informal markets and treatment abandonment,
expose patients to falsified products and
heightened health risks, as underscored by
WHO (2023).
The systemic drivers identified
—
manufacturing failures, dependence on
imports, procurement and pricing weaknesses,
logistics delays, and regulatory barriers
—
mirror international findings that shortages are
not isolated events but predictable outcomes of
fragile pharmaceutical systems (Bate et al.,
2023; Yaroson et al., 2024; Kanan et al., 2025;
Caviglioli et al., 2025). Import dependence, in
particular, poses a unique vulnerability for
Latin America, given its reliance on APIs and
finished products from Asia (Vargas, 2022).
Equity dimensions are critical. The study
shows that shortages disproportionately impact
low-income households and rural
communities, widening existing health
disparities. This finding aligns with global
concerns that shortages exacerbate inequities
by reducing access for those least able to
mitigate them (Limb, 2025; Baraniuk, 2024;
Santhireswaran et al., 2025). Addressing
shortages, therefore, is not only a matter of
pharmaceutical policy but also a question of
health justice and social protection.
In light of these findings, the following
policy recommendations are essential:
1.
Early warning systems with transparent,
real-time reporting of shortages (Yaroson
et al., 2024; World Health Organization,
2023).
2.
Resilient procurement models that
prioritize multi-supplier contracts and
resilience criteria over lowest-price tenders
(Shukar et al., 2021; Bate et al., 2023).
3.
Diversification of supply chains and local
production capacity, reducing dependence
on external suppliers (Vargas, 2022;
Gómez-Dantés et al., 2022).
4.
Regulatory flexibility during crises,
expediting imports and alternatives when
shortages are imminent (Caviglioli et al.,
2025; Lopert et al., 2022).
5.
Targeted measures to protect vulnerable
populations, ensuring that low-income and
rural groups retain access to essential
medicines (Acosta et al., 2019; Das et al.,
2023).
Ultimately, medicine shortages represent a
predictable systems failure rather than an
unforeseen anomaly. Tackling this challenge
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1048
requires coordinated action across
governments, regulators, industry, and
international organizations. The alignment of
our findings with international literature
(Acosta et al., 2019; Bate et al., 2023; Shukar
et al., 2021; Yaroson et al., 2024; Kanan et al.,
2025; Pandey et al., 2024; Rosário et al., 2024;
Limb, 2025; Baraniuk, 2024; Santhireswaran
et al., 2025; Caviglioli et al., 2025; Gómez-
Dantés et al., 2022; López & Sánchez, 2023;
Vargas, 2022; Bochenek et al., 2018; Das et al.,
2023; Lopert et al., 2022; Ravela et al., 2022;
World Health Organization, 2023) reinforces
the urgency of moving beyond reactive
solutions toward proactive, resilient, and
equity-focused policies.
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ACKNOWLEDGMENTS
The authors would like to express their sincere gratitude to
Dr. Jorge Angel Velasco Espinal
for his
invaluable guidance, constant support, and insightful contributions throughout the development of
this article. His leadership and dedication were essential in shaping the study’s design, analysis, and
interpretation. His commitment to advancing scientific knowledge in the field of global health and
pharmaceutical policy greatly enriched the quality and relevance of this work.
CONFLICT OF INTEREST STATEMENT
The authors declare that they have no conflicts of interest.
COPYRIGHT
Corona-Arias, C. A., Corona González, R. D., Martínez Salto, A. S., Paredes Ydiaquez, M. M.,
Vergara Trujillo, R. A., Castañeda López, E. Y., Guardiola Segovia, S., & Mercado Estrada, E. G.
(2025)
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