When Hurricane Helene hit North Carolina in September 2024, most people thought about flooded homes and downed power lines. But for hospitals across the U.S., the real crisis was quieter-and deadlier. Inside a single plant in North Cove, a machine stopped working. That machine made IV fluids. And when it went offline, the country ran out of saline bags, the most basic, life-saving fluid used in every ER, ICU, and operating room. Within 72 hours, hospitals began canceling surgeries. Cancer patients waited for chemo. Newborns went without hydration. This wasn’t a glitch. It was a system failure, made worse by climate change.
Why One Storm Can Shut Down the Nation’s Medicine Supply
Puerto Rico used to make 10% of all FDA-approved drugs in the U.S. And 40% of sterile injectables-like insulin, antibiotics, and IV fluids-came from just a few factories on the island. When Hurricane Maria smashed into Puerto Rico in 2017, it didn’t just knock out power. It destroyed the electrical grids that kept refrigerated drug production lines running. The result? A nationwide insulin shortage that lasted 18 months. Hospitals rationed doses. Diabetics skipped injections. Some died. That wasn’t an accident. It was predictable. Over 65% of U.S. pharmaceutical manufacturing facilities sit in counties that have seen at least one federal weather disaster declaration since 2018. Hurricanes, floods, wildfires-they’re not just weather events anymore. They’re supply chain shocks. The problem isn’t just location. It’s concentration. Most critical drugs are made in just one or two factories. For example, Baxter’s plant in North Carolina makes 60% of the country’s IV fluids. If that one facility goes dark, there’s no backup. No spare parts. No quick fix. It takes 6 to 12 months to build a new pharmaceutical plant. And 2 to 3 years to install the specialized, ultra-clean equipment needed to make sterile drugs. You can’t just order more from Amazon.What Drugs Are Most at Risk?
It’s not just the fancy, expensive medicines. The most vulnerable drugs are the old, cheap, generic ones that no one thinks about-until they’re gone.- IV fluids (saline): Used in every hospital, every day. One plant in North Carolina made 1.5 million bags daily. After Helene, shortages hit 90% of U.S. hospitals.
- Insulin: 80% of U.S. supply came from Puerto Rico before Maria. Even today, only two major manufacturers make the most common types.
- Sterile injectables: Antibiotics like vancomycin, painkillers like morphine, and emergency drugs like epinephrine. 78% of these have only one or two U.S. production sites.
- Infant formula: The 2022 Michigan floods hit Abbott’s Sturgis plant during an existing shortage. The delay pushed nationwide scarcity into its 8th month.
Why Hurricanes Are the Worst Threat
Not all disasters hit the drug supply the same way. Hurricanes are the biggest killers.- Hurricanes: Cause 47% of climate-related drug shortages. They knock out power for weeks, flood factories, and destroy transportation routes. Recovery takes 6 to 18 months.
- Tornadoes: 28% of disruptions. They hit hard but fast-like the 2023 tornado that damaged Pfizer’s plant in Rocky Mount, NC. It knocked out 27 specific drugs for 9 months.
- Floods: 19%. They ruin raw materials and packaging. The 2022 Michigan floods didn’t just stop formula production-they ruined millions of sealed containers.
- Wildfires & Heat: 6%. Less direct, but they disrupt logistics, damage storage facilities, and force shutdowns during peak demand.
What’s Being Done-And Why It’s Not Enough
The FDA now lists natural disasters as a top cause of drug shortages. That’s progress. But listing a problem isn’t fixing it. After Maria, the FDA created an emergency pathway to import drugs from Europe. It took 28 days. In a crisis, that’s too slow. Hospitals were running out of saline by Day 3. Some companies are trying. Sensos.io used AI to predict Helene’s impact 14 days ahead. A few hospitals used that warning to stockpile extra IV bags. That saved lives. But only 68% of big drugmakers now assess climate risk-and only 31% have actual plans to reduce it. The Strategic National Stockpile started piloting emergency supplies of critical injectables in hurricane zones. During Helene, that cut shortage duration by 40% compared to Maria. That’s a win. But the stockpile still holds enough for only a few days’ worth of demand. For a country of 330 million people, that’s not a safety net. It’s a Band-Aid.The Real Cost of Inaction
There’s a financial cost. The global market for pharmaceutical supply chain resilience is expected to hit $9.7 billion by 2029. But that’s not the real cost. The real cost is measured in delayed surgeries, missed chemo treatments, and preventable deaths. 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. And it’s not just about who gets sick. It’s about who gets left behind. Hospitals with 500+ beds are 3.2 times more likely to map their supply chains than small clinics. Rural hospitals, community health centers, and low-income urban clinics? They’re on their own.
What Needs to Change
Experts agree on three things:- Diversify production. Don’t make all your insulin in Puerto Rico. Don’t make all your IV fluids in North Carolina. Spread manufacturing across three climate-resilient zones-like the FDA’s new Critical Drug Resilience Program, launching in January 2025.
- Build strategic reserves. Keep 90 days of critical drugs in secure, geographically dispersed warehouses. The FDA’s proposed 2025 rule requiring this could prevent 60% of climate-related shortages.
- Fast-track approvals during disasters. Right now, getting emergency supplies approved takes weeks. It should take days. The FDA needs a real-time emergency channel, like a 911 line for medicine.
What You Can Do
You can’t build a new drug factory. But you can demand better.- Ask your doctor: "Is this medication at risk of shortage? Is there an alternative?"
- Support policies that fund drug supply resilience. Contact your representatives. Ask them to back the FDA’s 2025 rule on emergency inventories.
- Don’t hoard. Stockpiling drugs at home creates artificial shortages and wastes resources. Instead, stay informed and speak up.
Why do natural disasters cause drug shortages?
Natural disasters like hurricanes and floods damage pharmaceutical manufacturing plants, destroy power grids, and disrupt transportation routes. Many critical drugs are made in just one or two facilities, so when one shuts down, there’s no backup. It takes months to restart production, and even longer to build new facilities. This creates nationwide shortages of essential medicines like IV fluids, insulin, and antibiotics.
Which drugs are most likely to run out during a climate disaster?
The most vulnerable drugs are generic, sterile injectables used in hospitals: IV saline, insulin, antibiotics like vancomycin, painkillers like morphine, and emergency drugs like epinephrine. These are often made in single facilities with no redundancy. Infant formula and certain cancer drugs are also at high risk due to complex production and tight supply chains.
Are drug shortages getting worse because of climate change?
Yes. Between 2017 and 2024, climate-related disruptions caused 32% of all U.S. drug shortages. With more intense hurricanes and floods predicted, and over 65% of drug factories located in disaster-prone areas, shortages are expected to increase by 150% by 2030 if no changes are made.
Can the U.S. government fix this?
The FDA has started taking steps-like proposing rules that require manufacturers to keep 90-day emergency inventories and submit climate risk plans. A new program launching in January 2025 will fast-track approval for drugmakers who spread production across multiple climate-resilient regions. But progress is slow. Real change requires funding, regulation, and political will.
Should I stockpile medicine at home if a storm is coming?
No. Hoarding drugs creates artificial shortages and puts pressure on pharmacies and hospitals that serve vulnerable populations. Instead, talk to your doctor about alternatives, stay informed through official health alerts, and support policies that build long-term supply chain resilience.