Parents, pharmacists, and pediatricians have scrambled for months to find antibiotics for children amid one of the worst winters for respiratory illnesses, strep throat, and ear infections. Children's fever reducers, in particular, were missing from the shelves of pharmacies for weeks. It shouldn't be so hard to find common generic medicines.

But this is an ongoing problem that seems to get worse with time. Shortages have been commonplace for over a decade . Drugs crucial in labor and delivery , cancer treatment , and anesthesia , for example, frequently cycle on and off of shortage lists. More than 200 medications and solutions are currently on the American Society of Health-System Pharmacists' drug shortage list . And an astonishing 21 of the 36 drugs on the FDA's list of critical medications are in shortage .

A root cause of drug shortages is the legalized kickbacks enjoyed by Group Purchasing Organizations (GPO). GPOs are middlemen who write the exclusive contracts controlling the movement of medications, medical supplies, and devices — such as masks, gowns, ventilators, sterile solutions — into hospitals, hospital-owned clinics, and nursing homes. These supplies can account for up to 40% of a hospital’s overhead .

Just three GPOs control 90% of institutional supply . Since they were given an exemption from the anti-kickback statute in 1987, GPOs are able to contract with a wealthy manufacturer of essential medical products and allow them to be the sole supplier, irrespective of quality and cost.

Another critical issue: Nearly all of our nation’s drug-making supplies are imported from foreign manufacturers. Many of the manufacturers contracted with GPOs have offshored their production to decrease costs. In fact, 75% of the FDA’s critical medications have no U.S. supplier for ingredients . Thus, the U.S. cannot control the medication supply and must rely on other countries, particularly China.

China controls roughly 90% of the global supply of ingredients needed to make generic antibiotics that treat common and critical infections. It's a matter of national security that China has control of essential supplies and can choose to withhold, ration, or increase prices. We experienced the consequences of this during the pandemic when personal protective equipment was hard to come by and hospitals were forced to ration their own supply.

As China strengthens its relationship with Russia, it is imperative we act sooner rather than later to reduce dependence on foreign production. Companion bills called the Protecting our Pharmaceutical Supply Chain from China Act were introduced in the House and Senate last year to reduce our dependence on China and return medical manufacturing to the U.S. If signed into law, this bill would track the origin of active pharmaceutical ingredients and drugs through a registry and country of origin labeling, prohibit government healthcare programs from purchasing products with active pharmaceutical ingredients from China, and incentivize American companies to make drugs and medical equipment in the United States.

Lawmakers must also address GPOs' oversized role in medical manufacturing. There is no way to restore a functional and equitable domestic supply chain for medications and other medical supplies while wealthy, monopolized GPO middlemen have an exclusive right to accept kickbacks. Repealing GPO kickbacks as well as incentivizing U.S. manufacturers are both essential to encourage the return of U.S. medical manufacturing.

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Marion Mass, M.D. and Nikki Johnson, M.D. are pediatricians active in the Free2Care Coalition .