| A tornado that ripped through Pfizer's plant in North Carolina raising fears about further drug shortages; a hurricane that halted operations at an AstraZeneca facility in Puerto Rico; Cyclone Freddy that washed away antiretroviral drugs and mosquito nets in Malawi. Those are just three examples of how climate change is increasingly impacting medicine supply chains. And according to all climatic projections, it's only going to get worse. That's a major concern for the drug companies and organizations that have to deliver drugs and the patients across the globe who need them. Drugs are uniquely vulnerable to climate change. Strict manufacturing and distribution rules require proof that a medicine has been stored at specific temperatures from production until it sits in a patient's medicine cabinet, and has not been contaminated by factors such as humidity, moisture, light or dirt. Business continuity plans have always included provisions to manufacture drugs in two separate locations, particularly for medically critical and high value brands, says AstraZeneca's Juliette White, who is vice president of the company's work on sustainability. Now, companies also need to ensure that products aren't being manufactured and stored in similar climatic situations. "It's no longer enough merely to look at physical separation [and] geopolitical separation," White tells me. No region or country is immune from this issue. In fact, the example White gives is a place no one would expect extreme temperatures — Sweden. In the summer of 2018, AstraZeneca's facility outside Stockholm saw repeated days of elevated temperatures. It resulted in a reduction in production as the facility couldn't maintain the ambient temperature required under manufacturing rules. That summer's temperatures were viewed as extraordinary. But the worry from AstraZeneca, which makes some of the world's most in-demand cancer drugs, was: "What if it became the ordinary summer?" What followed was a series of investments, including new cooling towers and heat pumps to mitigate the impact of future increases in temperatures. For organizations that deliver critical medicines in some of the most vulnerable communities in the world, like the Global Fund to Fight AIDS, Tuberculosis and Malaria, climate change and health now loom large. "What you see is these weather related events causing issues in your supply chain from scarcity of drugs to inability to execute campaigns for malaria on a routine basis," Marasi Mwencha, the Global Fund's head of supply chain tells me. "Many of those facilities were not able to store drugs effectively in temperature controlled environments. But now we are seeing a need to do that, especially with rising temperatures." It's meant that practical considerations need to be taken early on when developing facilities. For example, in Nigeria, where a warehouse was being updated, Mwencha says the initial planning would have seen the facility built in a valley, which was at risk of flooding. That was changed after the risk to the integrity of the medicines being stored there was identified. In the past, climate changes might have meant buying products such as diesel generators. Both the Global Fund and AstraZeneca are trying to ensure that the investments they make don't contribute to further climate change. The investments themselves are costly, but as White sees it, they are critical. "None of us would want to be unable to give a patient medicine because we hadn't taken care of the physical environment in which that medicine was made and transported," she says. "That to me would be unforgivable." — Ashleigh Furlong | 
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