Category: The Conversation

Source: The Conversation – UK – By Emilia Vann Yaroson, Assistant Professor in Operations and Supply Chain Management, University of Sheffield

The UK continues to experience shortages of many common prescription drugs, despite efforts to strengthen supply chains.

Drugs for ADHD, epilepsy, GLP-1s for type 2 diabetes and weight loss, as well as ramipril (which is used to treat high blood pressure and heart failure), have all faced supply shortages since the end of last year or beginning of this year.

As products become unavailable, pressure increases across the system to secure alternatives. If patients do not receive treatment promptly and consistently, their quality of life can suffer.

Medicine supply shortages pose a significant threat to the UK’s public health. And, as a recent government inquiry revealed, the UK’s current medicine supply chain is very vulnerable to disruptions.

Making supply chains more resilient would normally have been the best strategy for ensuring the UK can maintain supplies of medicine and recover quickly when problems do occur. But growing global and supply chain pressures mean medicine shortages are likely to continue unless deeper system weaknesses are addressed.

Why shortages keep happening

Medicine supply chains are global, highly regulated and complex. Challenges such as factory maintenance, transport delays or rising demand in other countries can quickly affect medicine supplies in the UK.

Recent disruptions, such as the Iran conflict, have raised concerns about future medicines security. The war has already driven up the cost of some prescription drugs by 30%. This is largely due to the jump in gas and diesel prices, making manufacturing and shipping more costly.

The rising cost of raw materials and energy can also contribute to increasing drug costs for patients and healthcare systems.

The supply and demand for medicines can fluctuate as well depending on disease prevalence, access to diagnosis, market pricing and people’s ability to pay. For instance, ongoing HRT shortages have partly been blamed on increased demand for the drug following GP consultations.

It can therefore be challenging to ensure a constant supply of medication. But this is not just a UK issue – it’s a worldwide problem.

The UK competes globally for access to medicines and critical ingredients. Approximately 80% of the medicines used to treat UK patients are non-branded or “generics”. These are mainly manufactured in China and India. Generics are clinically effective but less expensive than branded drugs, so there’s a heavy reliance on them internationally.

China and India are also the primary manufacturers of many basic pharmaceutical ingredients. This increases global reliance on these countries. Manufacturing problems or transport delays in these countries can quickly reduce worldwide access to medicines.

Community pharmacies, which buy the medicines dispensed to patients in the UK, are directly affected by drug shortages. When medicines are not available and demand exceeds supply, market prices can rise quickly. These independent businesses may therefore be financially challenged by drug prices.

Although the Department of Health & Social Care (DHSC) has agreed prices and will refund pharmacies for the medicines they buy, the pharmacies can still make a loss on the purchases – and DHSC payments are always in arrears.

Patients usually access their medications through their local community pharmacy. But in the past five years, more than 1,000 community pharmacies have closed in the UK. Some of the causes of these closures are directly related to drug supplies, including medicine reimbursement and pressure due to shortages. Closing local community pharmacies puts pressure on the remaining pharmacies to maintain stock.

If patients cannot access their medicines, it can trigger panic orders and stockpiling, which may place even greater pressure on already fragile supply chains and waste. In some cases, these shortages also create opportunities for counterfeit medicines to infiltrate the market, as desperate patients seek alternative sources to meet their needs.

Low medicine prices have also been cited as a key reason for suppliers leaving the market or companies such as AstraZeneca reducing UK investment.

A lack of timely and informative communication about prescription drug shortages can lead to patient concerns, providers panicking and trading opportunism. Patients do not know why they can’t access their medicines or how long the situation will last.

What can we do?

There are calls from within the sector for earlier signalling of supply issues and changes in demand. This would give UK suppliers more time to find alternative medicines, plan production schedules, reduce delays and disruption and hopefully better prevent medicine shortages.

Effective and timely communication is also needed to support providers in doing their jobs and allay patient concerns.

Focusing on the pricing of medicines and its wider impact on our healthcare system is another important factor. The UK Life Sciences Sector Plan aims to support the sector and attract investors to strengthen local medicine production and reduce the impact of medicine shortages.

Educating stakeholders can help reduce medicine shortages by improving awareness, coordination and responsible behaviour across the supply chain. Educating community pharmacists and patients of the causes and impact of medicine shortages is also key. This can reduce panic orders, unnecessary stockpiling of medicines and prevent counterfeit or unregulated products entering the market.

The UK government should also collaborate more extensively with European partners by sourcing products from trusted or geographically close countries. This would not only promote stronger relationships but also create direct access to alternate medicine supply sources.

The current market leaders benefit from economies of scale and scope, however. More local and distributed manufacture may be stable but expensive. Key ingredients still often have single (or few) sources.

Improving supply resilience is essential for maintaining the availability of prescription drugs and reducing service pressures. But it isn’t the only strategy the UK government should rely on. Appreciation of the role of the patient and the provider as recipients is important in managing the impact and continuity of supply issues.

For patients experiencing shortages, it’s important you don’t panic buy and stockpile items, and continue ordering your prescription only when needed. Your pharmacist can also give you advice on what to do if your usual medicine is not in stock.

Liz Breen is affiliated with the House of Lords Public Select Committee Medicines Security Inquiry as a Specialist Advisor. She received funding from the House of Lords.

Emilia Vann Yaroson and Jonathan Silcock do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

– ref. Drug shortages continue to be a problem in the UK – yet strengthening supply chains alone won’t solve this issue – https://theconversation.com/drug-shortages-continue-to-be-a-problem-in-the-uk-yet-strengthening-supply-chains-alone-wont-solve-this-issue-282682

Source: The Conversation – UK – By Stephen Coleman, Emeritus Professor of Political Communication, University of Leeds

Beyond the high drama surrounding the Makerfield by-election and the contest to be the UK prime minister lies a more fundamental battle. It is the struggle between the incremental pragmatism of mainstream politics and the magical thinking of populism.

The great catchword of recent UK politics has been “change”. Brexit, it was said, would change the country’s declining position in the world. Boris Johnson said after his landslide electoral victory in 2019 that he was going to take on “the problems that no government has had the guts to tackle before”.

Labour’s 2024 election manifesto, entitled “Change”, declared that a Starmer-led government would “stop the chaos, turn the page, and start to rebuild our country”.

Read more:
English local elections 2026: a story of a new kind of politics

But people have different ideas of what change means and how fast it can happen.
In a world full of entrenched, unequal social structures and complex, intractable
global problems, change is inevitably a long-term project. But voters tend not to be in the business of long-term evaluation.

Similarly, they are not impressed by graphs showing that the UK economy is currently the fastest-growing in the G7 or that waiting times for NHS treatment in England are at their lowest level in more than three years.

There are undoubtedly better ways of communicating long-term change and
identifying quick wins than the current government has adopted. However, the real battle is not between rival tellers of the mainstream narrative, but between two completely different conceptions of change. Remembering this will be crucial for Andy Burnham when he takes on Reform UK in the Makerfield by-election in his bid to return to Westminster to challenge Keir Starmer for the leadership of the Labour party and his job as prime minister.

Feelings over facts

Populist leaders are successful not because they have more convincing policies for house-building, ending child poverty or realising energy security. The change they offer appeals to visceral feelings rather than material needs. “Imagine how you will feel on the day that we come to power,” they say. “Think of how shattered all of those people who have ignored you, talked down to you, taken your jobs and pushed ahead of you in the queue for services will feel.”

Populists such as Reform UK (according to current polls the most likely party to win the next UK general election) are less interested in setting out a policy programme than in connecting with voters’ raw nerves.

That is why the most crucial lesson for Labour from the 2026 local elections
was not their devastating defeat, but the unstoppable surge of Reform’s appeal to
voters that threatened to leave them in the margins in the next general election.
Labour’s reflex response was to depose its leader. And possibly at least one of Starmer’s rivals for the job would be more effective at taking on this new form of political opposition.

More important, however, is to be clear what is involved in taking on
populism. A new prime minister will be faced with exactly the same challenges as
the current one and will not be able to deliver transformative change simply by force of an appealing personality.

Europe will still be involved in its longest war since 1945. The US will continue to be an unreliable partner. The climate emergency will go on wreaking havoc. Social care for an ageing population will remain a massive challenge. National debt will still limit the capacity for public investment. Regional disparities and indefensible social inequalities will still exist.

All of these challenges and more will result in sections of the electorate feeling alienated and disappointed – the very sentiments upon which populism depends.

The big question for whoever is going to be prime minister in the next three years is not just about policy and delivery (although it is also very much about that), but about offering an alternative to the psychic appeal of populism. That will entail adopting a three-point strategy.

First, politicians need to acknowledge the depth of disappointment felt by people whose parents and grandparents had once believed that the government was there to look after them in times of need. The prime minister should declare an urgent mission to build an infrastructure of cradle-to-grave care, which exists not to tell people how they should be feeling, but to be democratically accountable to their needs and priorities as individuals and communities.

Second, there is a need for a complete overhaul of political language, led by the prime minister’s example, eschewing the lexicon of technocratic cliche and adopting the conversational tone of speaking with rather than speaking at people.

Third, there is a need for boldness in calling out the ugly sentiments of populism and appealing explicitly to the more generous, positive feelings and beliefs of the majority that are too often excluded from the domain of hardheaded politics.

A new prime minister will need to be imaginative in demonstrating that populists are not the only ones who can appeal to people’s deepest apprehensions and desires. And they will have to show that politics can be more like an inclusive conversation than a PowerPoint presentation. In that case, then perhaps the recent soap opera will not be as inconsequential as many people perceive it to be.

Stephen Coleman does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Labour in crisis: whoever is prime minister, voters expect politicians to use the language of populism – https://theconversation.com/labour-in-crisis-whoever-is-prime-minister-voters-expect-politicians-to-use-the-language-of-populism-283088

Source: The Conversation – UK – By Maria Ryan, Associate Professor in US History, University of Nottingham

Donald Trump’s appraisal of his recent state visit to China was, typically, positive and self-regarding. At the end of the trip, the US president told reporters that it had achieved “a lot of good” and “fantastic trade deals” had been signed. He concluded that a lot of different problems were settled “that other people wouldn’t have been able to solve”.

As usual, the US president appeared to enjoy the pageantry of a state visit. He likes meeting other “great” leaders – strongmen who lead powerful countries.

At face value, the trip appeared largely successful. The Trump-Xi relationship appeared cordial. There were no undiplomatic comments by Trump. Xi described it as “a milestone visit” of “historic” proportions. Trump said that his relationship with Xi is “a very strong one”. China pledged to buy 200 Boeing aircraft and also committed to buying billions of dollars of soybeans and other agricultural goods. These are all things Trump can present as wins, even if their significance is disputed.

The cordiality of the visit was a contrast to the Biden years, when “extreme competition” with China – in Biden’s words – was the central organising principle of US foreign policy. The Biden administration viewed China as a once-in-a-generation challenger to US power: politically, economically, militarily and ideologically. It believed Beijing was aggressively trying to displace the US as the world’s dominant power and actively sought to prevent this.

Over the past year, the second Trump administration has shifted attention away from great power conflict with China and focused on other things. These have included regime change in Venezuela (and, all the signs suggest, Cuba is now in his sights). He has changed America’s relationship with Europe, introduced an at-times erratic regime of tariffs in an attempt to address US trade deficits. And, above all, he has started a war with Iran.

Ely Ratner, a China hawk from the Biden administration has accused Trump of “strategic deference” towards Beijing. And there can be little doubt that the Trump administration has dialled down the Cold War-style ideological rhetoric about China.

Its 2025 national security strategy stresses that: “We seek good relations and peaceful commercial relations with the nations of the world without imposing on them democratic or other social change that differs widely from their traditions or histories.” This much was evident from Trump’s visit. Unlike Biden, Trump did not publicly raises human rights issues on his trip to China. This removed a persistent irritant in the relationship.

That said, the US Congress – and many of those around the president – still see the relationship with China as fundamentally competitive and adversarial. They want the US to remain the world’s primary power, militarily, economically and technologically. The desire to out-compete China is likely to drive policy in the longer-term.

The 2026 national defense strategy, published in January, states that Washington will be “clear-eyed and realistic about the speed, scale, and quality of China’s historic military buildup” and will “prevent anyone, including China, from being able to dominate us or our allies”. The strategy commits the US to deterring a Chinese invasion of Taiwan by keeping “a strong denial defense along the First Island Chain” north and south of Taiwan. The US secretary of state, Marco Rubio, who accompanied Trump to Beijing, confirmed that US policy on Taiwan has not changed as a result of the leaders’ meeting.

The Trump administration’s approach is driven primarily by economic interests. This is because it believes that “the Indo-Pacific will soon make up more than half of the global economy” and, according to the defense strategy: “Were China… to dominate this broad and crucial region, it would be able to effectively veto Americans’ access to the world’s economic center of gravity.”

This means the Trump administration will try to preserve the giant US military presence in Asia Pacific that the Chinese see as encirclement.

‘Conscious de-coupling’

The US president remains a mercurial character who can make unpredictable decisions. He likes to tout his prowess as a dealmaker and it is always possible that he could undermine the consensus view within his own government. But the US Congress is also firmly behind the drive to out-compete China and to “decouple” in advanced technology.

In July 2025, the bipartisan “One Big Beautiful Bill” Act (OBBBA) included US$58 billion (£43.5 billion) of federal investments in, and tax incentives for, AI production inside the US. These measures barred “prohibited foreign entities” from US supply chains. In 2018, Congress passed strict new export controls and investment restrictions into law to try to decouple from China in emerging new technologies. The House Select Committee on China is pushing for more of this.

Over the past year, the Trump administration launched a new strategy for rare earth metals. China’s dominance of the mining and processing of these metals is a huge advantage – they are critical to modern weapons systems and widely used in electronics, from smartphones to EVs.

In April 2025, Beijing began to impose export controls on rare earths in response to US tariffs. Since then, the US has launched a US$7.3 billion global effort to secure supplies of rare earths outside China and invest in domestic mining and processing capabilities. While this will take years to come to fruition, the goal is to speed up decoupling from China in rare earths – hardly a sign of trust.

Finally, Trump reportedly refused to extend the trade truce signed in October 2025 until the end of his administration as he believed he would lose leverage over China in future. It’s a clear sign that even he expects tension in future.

The Trump administration says that, unlike its predecessors, it is not looking for conflict with China. But its insistence on US dominance of Asia Pacific is likely to drive competition with China in the long-term.

Maria Ryan has received funding from the British Academy.

– ref. Trump’s ‘cordial’ Beijing trip has not changed superpower rivalry – https://theconversation.com/trumps-cordial-beijing-trip-has-not-changed-superpower-rivalry-283107