The U.S. Food and Drug Administration (FDA) has given Florida the green light to import select prescription drugs from Canada at lower cost. However, allowing the United States (U.S.) to pillage Canada’s drug supply would undoubtedly violate the pillars of medical ethics that include respecting an individual’s right to choose (autonomy); doing good (beneficence); doing no harm (non-maleficence); and delivering health care equitably (justice).
A limited drug supply may result in fewer treatment options available to patients, which infringes on the right to choose and limits autonomy. Additionally, patients may be subjected to undue harm if the medications they need are not available, and physicians may be unable to provide the highest quality of care if they are forced to contend with a lacklustre drug supply.
We have long-standing, strong relations with our American neighbours. We appreciate that Americans need access to affordable drugs. But taking them from Canada is not a fair, sustainable or equitable solution.
This “quick fix” proposition approved by the FDA could cause significant and long-term damage to Canadian health-care delivery.
Although protective regulations to prohibit drug exports during shortage periods are in place, there is no guarantee that increased demand from commercial purchasing by the U.S. won’t overwhelm the Canadian health-care system.
Canada’s Health Minister, Mark Holland, is not supportive of Florida’s intentions and said, “it’s inappropriate for U.S. politicians to look to Canada to help fix their costly health-care system, where sky-high drug prices are the norm.” He will travel to Washington, D.C., to ensure the message is clear: Canada will not allow foreign states to threaten the availability of medications for Canadians by pursuing bulk imports of popular pharmaceutical drugs.
Instead, U.S. policymakers should reign in Big Pharma with regulations that address the core issue of affordability and make locally manufactured drugs more accessible for Americans.
Most importantly, we must all recognize that the responsibility for U.S. drug shortages should not be shifted to Canada, but rather addressed at the root cause within the U.S. health-care system itself.
Canada currently depends on global markets to source most of its drugs; only a small proportion are made within the country. Opening the doors to additional external demands, such as Florida’s quest to import medications in bulk, adds unnecessary strain to Canada’s limited market, further weakening the health-care system. Since 2017, 10-15 per cent of drugs have been in short supply at any given time, a situation worsened by the COVID-19 pandemic, disrupting the supply of popular drugs and increasing the demand for essential medicines. As Florida contemplates importing large quantities of drugs from Canada, the question looms: Why can’t Florida buy directly from the same international sources as Canada?
With a population exceeding 22 million, Florida houses 55 per cent of Canada’s entire population (40 million). Additionally, Florida ranks second in the U.S. for its elderly population, constituting 21.3 per cent of its residents. Notably, Florida’s prevalence of diagnosed diabetes surpasses that of the entire Canadian population. Similarly, mental health disorders are more prevalent and the HIV rate is significantly higher.
Canada cannot afford to relinquish drugs to Florida without jeopardizing its health-care system.
These higher rates of chronic disease have led to an increased demand for essential drugs compared with the larger, but less disease-burdened Canadian population. The numbers speak volumes: Canada cannot afford to relinquish drugs to Florida without jeopardizing its health-care system.
If our health-care system is compromised in this way, the effects could be severe and wide-reaching. Given the alarming drug shortage in the country, any move to sell our limited supply to our southern neighbours would act in opposition to the interests of Canadians. This would signify a blatant prioritization of capitalism over health care; not dissimilar to what has been perpetuated by our American counterparts for decades.
The U.S. is the world’s largest producer of pharmaceutical drugs, so supply is not their biggest issue. The free-market economy afforded to the U.S. pharmaceutical sector means drug prices are not set by regulatory bodies, but by supply and demand. This neoliberal approach gives private companies the power to artificially control the drug supply and charge inflated prices, meaning that many citizens cannot afford to pay for lifesaving medications. The fact that even a century-old drug like insulin is unaffordable for many Americans is a stark example of America’s failure to regulate drug prices.
Indeed, drug prices in the U.S. are 2.18 times greater than in Canada. As such, Florida is looking to Canada as a “backdoor” solution to securing a lower cost supply. Lobbying by Big Pharma and ineffective price regulations by the U.S. government are the main forces driving extremely high drug prices. Rather than buying cheaper drugs from Canada, the U.S. should focus on fixing these dynamics to improve access and affordability for its citizens.
Canada needs to also keep pharma lobbying under check and work harder to enact the national Pharmacare legislation that will keep drug prices affordable for Canadians. If not, Canada might end up with the same drug affordability crisis as the U.S.
The good news?
Health Canada has released a statement against the Florida proposal, promising that officials are “… taking all necessary action to safeguard the drug supply and ensure Canadians have access to the prescription drugs they need.”
Now, the Government of Canada must remain firm in this position and continue to prioritize the health of its citizens while respectfully placing the burden of responsibility back onto the shoulders of U.S. political leaders and policymakers that oversee the U.S. health-care system.
