When Hurricane Maria hit Puerto Rico in 2017, it didn’t just knock out power and destroy homes-it also shut down the production of drug shortages that would last for years. At the time, one in ten FDA-approved drugs in the U.S. came from that island. One in four sterile injectables. Insulin. Saline. Antibiotics. All of it stopped. Hospitals scrambled. Patients waited. Some died because the medicine they needed simply wasn’t there.

That wasn’t an accident. It was a warning.

Today, climate change isn’t just about rising seas or hotter summers. It’s about whether your next prescription will be available. And the system is still dangerously unprepared.

Why Your Medicine Could Vanish After a Storm

Most people think drug shortages happen because of cost, profits, or bad management. But increasingly, they happen because of weather.

Over 65% of U.S. pharmaceutical manufacturing facilities sit in counties that have experienced a federally declared weather disaster between 2018 and 2023. Hurricanes, floods, wildfires-they don’t just damage buildings. They wipe out power grids, flood storage tanks, break cooling systems, and shut down production lines that can’t be restarted overnight.

Take Baxter International’s plant in North Cove, North Carolina. In September 2024, Hurricane Helene smashed into the region. That single facility made 1.5 million IV fluid bags every day-60% of the entire U.S. supply. Within 72 hours, hospitals nationwide began rationing saline. Elective surgeries were canceled. Cancer treatments delayed. Emergency rooms started using less fluid, knowing they might not get more for months.

This isn’t rare. After Hurricane Maria, insulin shortages lasted 18 months. Why? Because the power grid took 11 months to fix. And without stable electricity, you can’t make sterile drugs. Not even close.

One Factory, One Drug, One Disaster

The pharmaceutical industry doesn’t just rely on weather-prone areas-it relies on too few factories.

For 78% of sterile injectable drugs in the U.S., there are only one or two manufacturers total. That means if one plant goes down, there’s no backup. No spare parts. No alternative supplier. Just silence.

Before Hurricane Maria, Puerto Rico had 55 FDA-approved drug factories. One of them made 80% of the nation’s insulin. When it went offline, no other facility in the world could scale up fast enough to replace it. It took years to rebuild capacity.

And it’s not just Puerto Rico. In Spruce Pine, North Carolina, 90% of the high-purity quartz used in medical devices is mined. In Marion, North Carolina, Baxter’s IV fluid plant sits in a floodplain. In Rocky Mount, a tornado in 2023 shut down Pfizer’s facility, knocking out 27 specific medicines for over six months.

These aren’t isolated incidents. They’re structural flaws.

Why Hurricanes Are the Biggest Threat

Not all disasters hit drug supplies the same way.

Hurricanes cause the worst damage-accounting for 47% of all climate-related pharmaceutical disruptions. Why? Because they combine high winds, flooding, long-term power outages, and transportation shutdowns. They hit manufacturing hubs hard and leave them out for weeks or months.

Wildfires (28%) and floods (19%) also cause major problems, but they’re often more localized. A wildfire might burn a warehouse, but not a whole production line. A flood might ruin a storage room, but not the clean rooms where sterile drugs are made.

Hurricanes? They take out the whole system. Power. Water. Roads. Communication. Cooling. Everything. And because pharmaceutical production requires constant temperature control and sterile environments, even a 24-hour outage can ruin an entire batch.

After Hurricane Helene, the FDA estimated IV fluid shortages would last until mid-2025. That’s nearly a year of crisis-just from one storm.

A flooded pharmaceutical clean-room with robotic arms malfunctioning in floodwater.

Why the System Can’t Recover Fast Enough

You can’t just build a new drug factory when one gets destroyed.

It takes 6 to 12 months to open a new pharmaceutical facility. Two to three years to get the specialized equipment-clean rooms, sterilizers, automated filling lines-installed and certified. And that’s if you have the land, the permits, the skilled workers, and the money.

Meanwhile, hospitals are left with a few weeks of stock. No one keeps more than that. It’s too expensive. Too risky. The industry runs on “just-in-time” inventory-meaning drugs arrive the day they’re needed, not before.

That model works fine in normal times. But when a hurricane hits, it collapses. There’s no buffer. No safety net. Just panic.

During Hurricane Maria, some hospitals resorted to reusing IV bags after sterilizing them-something never approved by regulators. Others switched to oral fluids, even for patients who couldn’t swallow. These aren’t solutions. They’re survival tactics.

Who’s Trying to Fix This?

Some people are trying. But progress is slow.

The FDA now officially lists climate disasters as a top cause of drug shortages. In 2024, they proposed a new rule: manufacturers of critical drugs must keep 90-day emergency stockpiles and submit climate risk plans. That’s a start. But it’s not mandatory yet. And even if it passes, it’ll cost drugmakers 4-7% more to produce each medicine.

Some companies are testing AI tools to predict disasters. Sensos.io used weather models to forecast Hurricane Helene’s impact on IV fluid supply 14 days in advance. That gave a few hospitals time to stockpile. But most didn’t know. Most still didn’t act.

The Strategic National Stockpile is running small pilots-storing emergency IV fluids and antibiotics in hurricane zones. Early results show it cuts shortage duration by 40%. But the program covers only a handful of drugs and a few states.

Hospitals with over 500 beds are 3.2 times more likely to map their supply chains than small clinics. That means rural hospitals, community health centers, and nursing homes are the most vulnerable. They don’t have the staff, the budget, or the connections to prepare.

An underground emergency drug bunker with glowing medicine pods and holographic storm warnings.

What’s at Stake

It’s not just about saline or insulin.

It’s about cancer drugs. Antibiotics. Epinephrine. Insulin. Painkillers. Vaccines. All of them rely on the same fragile system.

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 getting worse. NOAA predicts a 25-30% increase in Category 4 and 5 hurricanes by 2030. That means more storms hitting the same coastal and southern manufacturing zones.

Right now, only 31% of major drugmakers have done more than assess their climate risks. Most still treat it like a future problem. But the future is here.

What Needs to Happen

This isn’t about blaming companies or regulators. It’s about redesigning a system that was built for a different world.

Here’s what’s needed:

  • Geographic diversification: No single drug should come from one region. Production must be spread across multiple climate-resilient zones-like the Midwest, Mountain West, or Northeast-away from floodplains and hurricane paths.
  • Strategic stockpiles: The government must fund and maintain emergency reserves of critical drugs-not just for hospitals, but for pharmacies, clinics, and nursing homes.
  • Regulatory flexibility: The FDA needs faster pathways to approve alternative suppliers during disasters. The 28-day delay during Maria was deadly. It can’t happen again.
  • Supply chain transparency: Every hospital and pharmacy must know where their drugs come from-not just the brand name, but the factory, the country, the backup plan.
  • Public investment: The U.S. needs to spend $12-15 billion over the next decade to rebuild this system. That’s less than 1% of annual healthcare spending. But it could prevent 70% of future shortages.

These aren’t radical ideas. They’re basic safety measures. Like fire codes for buildings. Or backup generators for hospitals. We accept them in other areas of public health. Why not for medicine?

What You Can Do

As a patient, you can’t fix the supply chain. But you can be prepared.

  • If you take a critical drug-like insulin, epinephrine, or heart medication-ask your pharmacist: “Is there a backup source if this runs out?”
  • Keep a 30-day supply on hand if possible. Insurance often allows early refills during emergencies.
  • Sign up for alerts from your local health department or the FDA’s drug shortage page.
  • Advocate. Call your representative. Ask them to support the FDA’s proposed rule on emergency stockpiles.

Medicine shouldn’t be a gamble. Not when we know the storms are coming.

Can natural disasters really cause drug shortages?

Yes. Natural disasters like hurricanes, floods, and wildfires directly damage pharmaceutical manufacturing facilities. After Hurricane Maria in 2017, 30% of U.S. drug production stopped because Puerto Rico housed 10% of all FDA-approved drugs. In 2024, Hurricane Helene shut down a single plant that made 60% of the U.S. IV fluid supply, triggering nationwide shortages.

Why don’t drug companies have backup factories?

Making drugs is expensive and tightly regulated. Most companies rely on a few high-efficiency factories to keep costs low. Building new ones takes years and millions of dollars. With low profit margins on generic drugs, there’s little financial incentive to create redundancy. This creates single points of failure-meaning if one plant goes down, the drug disappears.

Which drugs are most at risk during climate disasters?

Sterile injectables are the most vulnerable-things like IV fluids, insulin, antibiotics, and epinephrine. These require clean rooms, constant refrigeration, and precise manufacturing. They can’t be easily switched to oral forms or substituted. Generic drugs are especially at risk because they’re made by fewer companies and have thinner profit margins, so there’s less investment in resilience.

Is the FDA doing anything to prevent this?

Yes. In 2024, the FDA proposed a rule requiring manufacturers of critical drugs to maintain 90-day emergency stockpiles and submit climate risk plans. They’ve also created faster approval paths for imports during emergencies. But these measures aren’t yet mandatory, and implementation is slow. Many hospitals still lack the tools or funding to prepare.

What can patients do if their medicine runs out?

If you rely on a critical medication, keep a 30-day supply on hand when possible. Ask your pharmacist about alternative brands or sources. Contact your doctor immediately if you’re at risk of running out. Sign up for FDA drug shortage alerts. And don’t hesitate to advocate-contact your elected officials to support stronger supply chain protections.

Climate change isn’t a future threat to medicine. It’s a present danger. And the longer we wait to fix the system, the more lives we’ll risk.