When Hurricane Helene hit North Carolina in September 2024, it didn’t just knock out power and flood homes-it cut off the U.S. supply of IV fluids. Within three days, hospitals across the country were rationing saline bags. Cancer patients had to delay treatments. Newborns in NICUs were put on reduced fluid doses. Emergency rooms scrambled to stretch every last drop. This wasn’t a glitch. It was a predictable failure of a system built for efficiency, not survival.

Why One Storm Can Shut Down the Nation’s Medicine Supply

Puerto Rico used to make 10% of all FDA-approved drugs in the U.S. Today, it still makes 40% of sterile injectables-things like insulin, antibiotics, and saline. That’s because the island had cheap labor, tax breaks, and stable infrastructure. But it also had one major flaw: every single one of those factories relied on the same grid, the same ports, the same roads. When Hurricane Maria hit in 2017, the power stayed out for 11 months. Insulin production stopped. Hospitals ran out. Patients died waiting. It took 18 months to fully recover.

Fast forward to 2024. Hurricane Helene wiped out Baxter International’s plant in North Cove, North Carolina. That one facility made 60% of the country’s IV fluids. No backup. No spare machines. No alternative supplier. Within 72 hours, the FDA issued a national alert. By October, over 300 hospitals had implemented crisis protocols. Elective surgeries were canceled. Emergency rooms started using oral fluids instead of IVs-even though that’s not always safe or effective.

This isn’t an isolated event. Between 2017 and 2024, climate-related disasters caused 32% of all drug shortages in the U.S. That’s more than raw material shortages, labor strikes, or regulatory delays. Hurricanes, floods, and wildfires are now the leading cause of medicine shortages.

The Hidden Geography of Risk

Most people think drug manufacturing happens in big cities or overseas. But the truth is, the U.S. pharmaceutical supply chain is dangerously concentrated in a few vulnerable places.

- Puerto Rico: 55 FDA-approved drug plants before Maria. Still produces 80% of U.S. insulin. - Western North Carolina: Home to Baxter’s IV fluid plant and the quartz mines that supply 90% of the ultra-pure silicon used in medical devices. - Michigan: Abbott’s Sturgis plant, which made infant formula, flooded in 2022-just as the country was already in the middle of a formula crisis. - California and Texas: Wildfire zones where multiple generic drug manufacturers have facilities.

A 2024 study found that 65.7% of all U.S. pharmaceutical manufacturing facilities are located in counties that have had a federal weather disaster declaration since 2018. That means more than two-thirds of the medicine you take could vanish if a storm hits nearby.

And it’s not just about the factory. It’s about the supply chain behind it. One plant might make the drug, but the glass vials? Made in Ohio. The plastic tubing? From Alabama. The chemicals? Imported from India, shipped through a port in Louisiana. Break one link, and the whole thing collapses.

Why There’s No Backup Plan

You’d think drug companies would build redundancy-extra factories, spare machines, stockpiles. But they don’t. Why? Because it’s expensive.

The pharmaceutical industry runs on “just-in-time” inventory. That means they make drugs only when they’re needed. No extra stock. No warehouse full of insulin. No spare IV bags sitting in a climate-controlled vault. It saves money-until a hurricane hits.

Even worse: 78% of sterile injectable drugs in the U.S. have only one or two manufacturers. If one plant goes down, there’s no one else to pick up the slack. Take vancomycin, a critical antibiotic for MRSA infections. Only two companies make it. One of them is in Puerto Rico.

The lead time to build a new pharmaceutical plant? Six to twelve months. To install specialized equipment? Two to three years. That’s not a problem when you’re planning ahead. But when a storm hits with no warning, those timelines don’t matter. You can’t wait two years for a new IV fluid line when your hospital is running out today.

What’s Being Done-And What’s Not

After Hurricane Maria, the FDA created an emergency pathway to import drugs from other countries. It took 28 days to get saline from Europe. In 2024, during Helene, some hospitals used AI tools to predict the shortage 14 days in advance. That gave them time to order extra stock. But only a few did.

The Strategic National Stockpile now has a pilot program storing critical injectables in hurricane-prone states. During Helene, it reduced shortage duration by 40% compared to Maria. That’s progress. But the stockpile only holds enough for 10% of the country’s needs.

The FDA is proposing a new rule in 2025: drugmakers must keep a 90-day emergency supply of critical medications and submit climate risk plans. That’s a start. But it only applies to a small list of drugs-mostly injectables. What about oral antibiotics? Heart medications? Chemo drugs? Those aren’t covered.

Meanwhile, only 31% of top pharmaceutical companies have done anything meaningful to reduce their climate risk. The rest are still betting that the next storm won’t hit their plant.

Who Pays the Price?

It’s not the CEOs. It’s not the investors. It’s the patients.

Cancer patients are hit hardest. Older generic drugs-like those used in chemotherapy-are already in chronic shortage. When a hurricane hits, those shortages get worse. The American Cancer Society found that 70% of oncology clinics had to delay or change treatment plans during the 2024 IV fluid crisis.

Newborns. Elderly patients. People with kidney disease. All of them depend on IV fluids. When those run out, hospitals have to improvise. Some use less fluid. Others use cheaper, less effective substitutes. In one hospital in Georgia, nurses had to dilute saline bags to make them last longer. That’s not medical care. That’s triage.

And the worst part? Smaller hospitals and rural clinics have no resources to prepare. They don’t have teams mapping their supply chains. They can’t afford AI forecasting tools. They rely on distributors who don’t know where their drugs come from. When disaster strikes, they’re the last to know-and the first to run out.

What Needs to Change

There are solutions. But they require political will, not just corporate goodwill.

• Build regional resilience hubs: Create geographically分散 (distributed) manufacturing zones for critical drugs-on the East Coast, West Coast, and Midwest-so one storm doesn’t take out the whole country.
• Mandate emergency stockpiles: Require 90-day reserves for all life-saving generic drugs, not just a handful.
• Fast-track approvals for backup suppliers: Let the FDA approve alternative manufacturers during disasters without waiting months for paperwork.
• Invest in climate-proof infrastructure: New drug plants should be built on higher ground, with backup power, flood barriers, and water independence.
• Support small hospitals: Give rural clinics funding and tools to map their supply chains and access emergency stockpiles.

The pharmaceutical industry says it’s too expensive to make these changes. But how much does it cost when a cancer patient misses a dose? When a newborn goes without fluids? When a diabetic runs out of insulin because a storm took out a single factory?

The cost isn’t just financial. It’s measured in lives.

The Future Is Already Here

By 2030, climate models predict a 25-30% increase in Category 4 and 5 hurricanes. The number of extreme weather events is rising. The FDA says 65.7% of drug plants are already in harm’s way.

If nothing changes, experts predict climate-related drug shortages will increase by 150% by 2030. Cancer patients could face treatment delays during 8-10 major disasters every year.

We’ve seen this movie before. Hurricane Maria. The formula shortage. Helene. Each time, we say, “Never again.” And each time, we do nothing until the next storm hits.

The medicine you need to survive shouldn’t depend on the weather. It shouldn’t depend on where a factory was built 30 years ago. It shouldn’t depend on whether a company decided to cut costs instead of preparing for the future.

The system is broken. And the people paying the price aren’t CEOs. They’re the ones lying in hospital beds, waiting for a bag of saline that never came.