When storms hit, so do medicine shortages

It’s not just homes and roads that get destroyed in a hurricane. When Hurricane Helene slammed into North Carolina in September 2024, it didn’t just knock out power-it shut down the single factory producing 60% of the United States’ IV fluids. Within three days, hospitals across the country were rationing saline bags. Cancer treatments were delayed. Emergency rooms couldn’t flush IV lines. Patients on dialysis had to wait. This wasn’t a fluke. It was the new normal.

Drug shortages tied to climate disasters are no longer rare events. They’re becoming predictable, and they’re killing people. Between 2017 and 2024, nearly one-third of all drug shortages in the U.S. were directly caused by weather disasters, according to the FDA. And it’s only getting worse. Climate models predict a 25-30% increase in Category 4 and 5 hurricanes by 2030. Meanwhile, over 65% of U.S. drug manufacturing facilities sit in counties that have already been hit by at least one major weather disaster since 2018.

Why Puerto Rico and North Carolina are the weak spots

The problem isn’t just that storms are stronger-it’s where the medicine is made. Puerto Rico became the epicenter of U.S. pharmaceutical production because of tax breaks and skilled labor. But it’s also an island in the hurricane belt. Before Hurricane Maria in 2017, it produced 10% of all FDA-approved drugs and 40% of sterile injectables. After the storm, 46 manufacturing plants lost power. Some didn’t come back online for over a year. Insulin, antibiotics, and saline solutions vanished. Hospitals rationed. Patients died.

Today, the same pattern repeats on the mainland. Western North Carolina is now the new Puerto Rico. Baxter’s plant in North Cove makes 1.5 million IV bags a day-60% of the nation’s supply. Another facility in Marion makes critical injectables. Spruce Pine supplies 90% of the high-purity quartz used in medical devices. All of these are in a region increasingly prone to extreme rainfall, flash floods, and powerful storms. One hurricane, one power outage, one flooded warehouse-and the entire country feels it.

And it’s not just hurricanes. Tornadoes, floods, and wildfires are hitting drug factories too. In 2023, a tornado destroyed part of Pfizer’s plant in Rocky Mount, North Carolina, knocking out 27 specific medicines. In 2022, flooding at Abbott’s Sturgis, Michigan facility extended the infant formula crisis by eight weeks. Each disaster hits a different part of the chain, but the result is always the same: patients go without.

Why there’s no backup plan

Here’s the brutal truth: there’s almost no redundancy. For 78% of sterile injectable drugs in the U.S., there are only one or two factories that can make them. That’s not a coincidence-it’s business. Companies cut costs by centralizing production. One big plant is cheaper than three small ones. They rely on just-in-time inventory, meaning they keep only weeks of stock on hand. That works fine until the power goes out or the road to the factory is washed away.

Even if a company wanted to build a backup plant, it’s not easy. It takes six to twelve months to get a new pharmaceutical facility up and running. Specialized equipment-like sterile filling machines-can take two to three years to order and install. And the FDA has to approve every change. During a crisis, that’s not fast enough.

When Hurricane Maria hit, it took 28 days just to get emergency shipments of saline from Europe approved. By then, hospitals had already started turning away patients. That’s not resilience. That’s a system designed for efficiency, not survival.

Who gets left behind

Drug shortages don’t affect everyone equally. Cancer patients are hit hardest. Many of the drugs in chronic shortage are older, generic injectables-like doxorubicin, vincristine, and epinephrine. These aren’t fancy new medicines. They’re cheap, essential, and made by companies with thin margins. When a factory goes down, there’s little profit incentive to rush a backup line.

Hospitals with fewer than 500 beds are also more vulnerable. Big systems like Mayo Clinic have spent years mapping their entire supply chain-from raw ingredients to final delivery. They know exactly which suppliers make which components. Smaller hospitals? They don’t have the staff or money to do that. When a shortage hits, they’re the last to hear about alternatives, the last to get emergency stock, and the first to run out.

And then there’s the human cost. Nurses spend 12 to 24 hours per product just trying to stretch existing supplies-checking expiration dates, adjusting dosages, finding substitutes. That’s time taken away from patient care. In rural areas, patients drive hours to find a hospital with medicine. Some don’t make it.

What’s being done-and why it’s not enough

Some progress is happening. The FDA launched its Critical Drug Resilience Program in January 2025. It fast-tracks approval for manufacturers who spread production across three different climate-resilient regions. That’s a start. The Strategic National Stockpile is now piloting emergency stockpiles of IV fluids and insulin in hurricane-prone states. Early results show it cuts shortage duration by 40%.

Companies are also using AI to predict disasters. Sensos.io, a supply chain analytics firm, flagged Hurricane Helene’s threat to IV fluid supplies 14 days in advance. A few hospitals used that warning to stockpile. Others didn’t. The difference? Preparation.

But most efforts are still reactive. The FDA’s proposed 2025 rule would require manufacturers of critical drugs to keep 90-day emergency inventories and submit climate risk plans. That’s a big step. But it’s not mandatory yet. And even if it passes, it will raise production costs by 4-7%. That means higher drug prices-or less profit for manufacturers, which could lead to even fewer companies willing to make these essential drugs.

Some experts argue we need to bring more manufacturing back to the U.S. But Harvard’s Aaron Kesselheim warns that forcing domestic production won’t fix the problem if those new factories are still in flood zones. The real solution? Build in safer places. Use climate data to pick locations. Spread out production. Stop gambling with people’s lives.

What you can do

As a patient, you can’t control where drugs are made. But you can be aware. If you take a critical medication-especially insulin, IV fluids, or cancer drugs-ask your pharmacist: Is there a backup plan if this runs out? Know your alternatives. Ask about generic versions. Keep a list of your medications and dosages in case you need to switch.

If you’re part of a healthcare organization, push for supply chain mapping. It takes six to nine months, but hospitals that did it cut their response time by 65%. That’s the difference between scrambling and staying calm during a crisis.

And if you care about public health, speak up. Demand that lawmakers support the FDA’s proposed rules. Push for funding to build climate-resilient drug production. This isn’t just about medicine-it’s about who gets to survive when the next storm hits.

What’s next

The numbers don’t lie. Without major changes, climate-related drug shortages will increase by 150% by 2030. Cancer patients could face treatment delays during 8 to 10 major storms every year. That’s not a prediction. It’s a projection based on current trends.

The good news? We know what works. Stockpiling. Geographic diversification. AI forecasting. Regulatory flexibility. But none of it will happen unless we treat drug supply chains like the critical infrastructure they are-like power grids and water systems. Because when the medicine runs out, no one gets a second chance.