Climate change drives drug demand for chronic conditions

Climate change and health

According to the report, climate change is expected to increase the frequency and intensity of extreme weather events, including heatwaves, hurricanes and wildfires, leading to a rise in the prevalence of various health conditions. The environmental scan conducted by RAND researchers identified several climate-vulnerable health conditions, such as maternal-fetal health issues, cardiovascular disease, respiratory disorders like asthma, chronic obstructive pulmonary disease and kidney disease.

In addition to these, the report highlights vector-borne diseases, water-borne infectious diseases, mental health disorders and neurodegenerative diseases, such as Alzheimer's.

The growing prevalence of these conditions is anticipated to significantly alter the demand for pharmaceutical products, especially for those already experiencing supply chain challenges. Without appropriate planning, drug shortages -- already a significant issue -- could become more frequent, adversely affecting health outcomes and healthcare costs.

Projected drug demand for key chronic conditions

The RAND study developed a systems dynamics model to estimate the impact of climate change on drug demand for four chronic conditions that are not only highly prevalent but also associated with significant morbidity and mortality.

These conditions include the following:

• Cardiovascular disease, treated with metoprolol.
• Asthma, treated with albuterol.
• End-stage renal disease (ESRD), treated with heparin.
• Alzheimer's disease, treated with donepezil.

The model simulates future drug demand from 2024 to 2040 under five climate change scenarios based on the Shared Socioeconomic Pathways (SSPs) used by the Intergovernmental Panel for Climate Change. Each scenario corresponds to different levels of greenhouse gas emissions, with SSP1 representing a low-emission scenario and SSP5 representing a high-emission, severe climate change scenario.

Key findings for pharmaceutical stakeholders

Key projections from the RAND model include the following.

• Metoprolol (for cardiovascular disease) is expected to experience a slight decline (0.4%-0.9% ) due to the increasing mortality rates associated with climate change and its impact on overall health.
• Albuterol (for asthma) is expected to grow in demand by 1.5%-3% as worsening air quality affects respiratory health.
• Heparin (for ESRD) is anticipated to increase in demand by 4.4%-8.5% due to patients' vulnerability to climate-related factors.
• Donepezil (for Alzheimer's disease) is projected to rise in demand by 17.%5-33.1% as more elderly individuals are affected.

Cardiovascular disease -- metoprolol demand

Cardiovascular disease remains a leading cause of death in the U.S., and climate change is expected to exacerbate conditions such as hypertension and heart failure. The RAND model indicates that cardiovascular disease prevalence might decrease slightly under severe climate scenarios due to higher disease-specific and general mortality rates, leading to a potential 0.4%-0.9% reduction in demand for metoprolol by 2040. This surprising finding highlights the complex interplay between rising disease incidence and increased mortality from extreme weather events.

Asthma -- albuterol demand

Climate change is expected to worsen air quality and increase exposure to allergens, leading to increased asthma prevalence. The model projects a 1.5%-3% increase in demand for albuterol by 2040 under severe climate scenarios. This increase is attributed to higher rates of respiratory exacerbations driven by elevated levels of ground ozone, particulate matter, and pollen, which are linked to longer and more severe allergy seasons.

ESRD -- heparin demand

Patients with ESRD are particularly vulnerable to the effects of climate change, as dehydration and heat stress can exacerbate kidney damage. The report estimates that demand for heparin, an essential anticoagulant used during hemodialysis, could increase by 4.4%-8.5%. The anticipated rise in ESRD prevalence is driven by both increased incidence and longer survival of patients receiving hemodialysis, despite the overall higher mortality rates associated with climate change.

Alzheimer's disease -- donepezil demand

As a neurodegenerative disease primarily affecting the elderly, Alzheimer's disease is expected to become even more prevalent due to climate change's impact on vulnerable populations. Under severe climate scenarios, the model predicts a dramatic 17.5%-33.1% increase in demand for donepezil by 2040. This substantial rise in demand results from increased disease prevalence and improved survival rates, which together lead to a greater cumulative disease burden.

Strategic considerations

The RAND report's projections are a wake-up call for the pharmaceutical industry to consider climate change as an environmental issue and a fundamental business risk that could disrupt global supply chains. The anticipated increases in drug demand, particularly for generics that have already experienced shortages, call for reevaluating current supply chain strategies.

Supply chain resiliency

The pharmaceutical industry must invest in building more resilient supply chains that can withstand the pressures of climate change. This could involve stockpiling high-demand drugs, diversifying supplier bases and expanding both U.S.-based and international production capabilities. Moreover, the report highlights the importance of planning for increased demand for generic drugs, like metoprolol and albuterol, which are more susceptible to shortages.

Policy and regulatory implications

Regulatory bodies like the FDA might need to be more proactive in monitoring and mitigating drug shortages linked to climate-related demand surges. Policies encouraging stockpiling incentivize the production of critical drugs, and streamlining the approval of alternative suppliers could be instrumental in ensuring continuous access to essential medications.

Innovation and drug development

As demand for certain drugs rises, there might be opportunities for innovation in drug formulations and delivery methods. For example, inhalable or transdermal versions of commonly used drugs could improve patient compliance and reduce the strain on traditional supply chains. Additionally, advances in predictive modeling could help anticipate climate-related changes in drug demand more accurately, allowing companies to allocate resources more effectively.

Public-private partnerships

Collaborations between pharmaceutical companies, healthcare providers and government agencies will be crucial to addressing the challenges outlined in the RAND report. Public-private partnerships could support the development of new manufacturing technologies, enhance emergency preparedness, and improve the resiliency of the medical supply chain.

This report emphasizes the need for comprehensive strategies to address drug shortages and ensure equitable access to essential medicines for the most vulnerable populations by outlining the potential future impacts of climate change on drug demand. As the climate changes, the pharmaceutical industry and its supply chain must adapt to this new reality, leveraging innovation, collaboration, and strategic planning to safeguard public health in an increasingly uncertain world.

Alivia Kaylor is a scientist and the senior site editor of Pharma Life Sciences.