Global Shortages of Essential Medicines: Public Health Challenges and Policy Solutions

Resumen

The global shortage of essential medicines has emerged as a persistent and multifaceted public health challenge, driven by structural, economic, and regulatory vulnerabilities within the international pharmaceutical supply chain. This review analyzed twenty scientific and institutional sources from North America, Europe, and Latin America—specifically Mexico, Colombia, and Ecuador—to identify the primary determinants, patterns, and responses associated with this phenomenon. Results show a steady increase in global shortages between 2014 and 2025, largely due to the concentration of active pharmaceutical ingredient (API) production in a few countries, low-profit margins discouraging redundancy among generic manufacturers, and fragmented regulatory frameworks that delay mitigation. High-income regions such as the United States and the European Union have developed preventive, data-driven strategies, including early-warning systems, quality risk management, and Shortage Prevention Plans (SPPs). In contrast, Latin America remains dependent on imports, limited domestic production capacity, and reactive procurement mechanisms. The proposed eight-pillar framework integrates governance, manufacturing diversification, resilient procurement, regulatory agility, data transparency, clinical stewardship, and regional cooperation as interdependent dimensions for building pharmaceutical resilience. These findings highlight that shortages are not isolated technical issues but manifestations of systemic governance failures that threaten equity, continuity of care, and trust in health institutions. Ensuring the continuous availability of essential medicines demands a paradigm shift from reactive management to preventive, coordinated, and ethically grounded governance aligned with Sustainable Development Goal 3. Future research should focus on quantitative modeling of supply-chain vulnerabilities, cost-effectiveness analysis of resilience investments, and region-specific studies to design adaptive policies in Latin America and other low- and middle-income regions.