From syringes to stents: Iran war exposes NHS dependency on petrochemicals

The war in Iran has put the NHS on high alert due to fears of looming shortages and rising costs for medicines and medical products such as syringes, intravenous bags, and gloves. Much of modern healthcare relies on petrochemicals now held up by Gulf shipping disruptions, impacting both active pharmaceutical ingredients and the production of millions of sterile single-use items—ranging from personal protective equipment (PPE) to catheters and diagnostic-device casings. The NHS is one of the world’s largest healthcare bulk buyers, spending £8bn annually on equipment and consumables, from latex gloves and paper towels to stents and prosthetic hips. Its 2024-25 medicine bill was £21.6bn. Temporary shortages of certain drugs and equipment are common, but the Iran war threatens to widen and deepen these issues globally, pushing up costs and sparking a scramble for supplies. ‘Huge shock’: NHS England CEO Jim Mackey is “very worried” about supply chain challenges, warning the NHS may need extra government funding if the war leads to a “huge shock” of price increases. Climbing oil prices and supply disruptions from the Iran war are expected to severely impact the NHS. NHS England has increased purchases of drugs and devices to build up buffers, though no shortages exist currently due to the NHS’s ability to source supplies as a major buyer. However, prolonged conflict could change this. Damage to energy infrastructure and mines in the Strait of Hormuz is likely to extend disruptions further. NHS Supply Chain, the central procurement body, manages sourcing and delivery of over 620,000 products, including clinical consumables and medical equipment for NHS trusts. Tom Brailsford, head of resilience, says stocks have been increased “where appropriate,” and the organization is discussing supplier continuity plans and logistics routes. Airports in the Middle East remain disrupted, and airlines are cutting flights due to jet fuel access concerns. In normal times, Dubai and Doha are key hubs for medicine air freight moving to Europe from India, known as the world’s pharmacy, where most off-patent drugs are produced. ‘Dual problem of airspace and logistics chains’: Richard Sullivan, professor of cancer and global health at King’s College London, notes that supply chains for most cancer drugs are thin, often relying on a single supplier. These chains are complex, with long routes, making them vulnerable to disruptions. The NHS is urged to ‘think twice about how much it’s using’ single-use items to reduce waste, as shortages could force more cautious usage. Soaring prices: The cost of common medical items has risen since the war began. A box of 1,000 synthetic rubber gloves now costs 40% more at $29 (£21.50), according to CIMB Securities. Sustained disruptions could lead to glove shortages by late May. The surging price of naphtha, a refined crude oil byproduct used in petrochemicals, has driven up costs for medical equipment. Polyco Healthline, a major NHS contractor, raised prices by 10.3% to 26.3% from 1 April, signaling further increases. Malaysian condom-maker Karex, which supplies gloves, catheters, and probe covers, is increasing prices by 20% to 30%. Top Glove, the largest glove manufacturer, has passed on 50% cost increases due to higher nitrile latex prices. About 60% of naphtha used in Asia is sourced from or routed through the Middle East. Shortages have prompted shutdowns at Asian chemical makers, releasing them from contractual obligations. European prices for polyethylene and polypropylene, also made from naphtha, roughly doubled between February and April. The price of polyester fiber, used in surgical masks, gowns, drapes, wipes, dressings, and bandages, surged by 28% from late February to late March. Fibre shortages are anticipated by the end of May. The price of PET resin, used in pharmaceutical bottles and blood collection tubes, surged by 55% from February to March. ‘Price gouging concerns’: Sullivan notes that some price increases may be reasonable, but there is evidence of price gouging. The NHS pays some of the lowest prices globally, but shortages will arise if manufacturers prioritize countries that pay more. Liz Breen, professor of health service operations, says the NHS may have to pay higher prices for products during the conflict. The UK’s Department of Health and Social Care states they have robust measures in place, including buffer stocks and alternative product procurement, to protect patients. Volatility and scarcity: Drugmakers hold eight weeks’ worth of medicines, and equipment makers have buffer stocks. However, in many areas, there are few suppliers—such as the market in IV bags, dominated by US company Baxter and German firms Fresenius Kabi and B Braun Medical. Scott Lehmann, a supply chain expert at Sphera, notes that incentives for stocking items like syringes are low because they are traditionally always available. ‘Volatility is a feature in the system,’ he adds. Unlike other industries, healthcare cannot stop due to supply shortages—it must continue operations. The UK’s and Europe’s ‘just-in-time’ supply chains may face challenges, requiring investment and bringing manufacturing closer to home. Brailsford says NHS Supply Chain is working closely with suppliers and system partners to minimize cost pressures and avoid unnecessary changes to clinical practice. The UK’s Department of Health and Social Care confirms they have measures in place to manage disruptions across the health and social care sector, including buffer stocks and procurement of alternative products where necessary. The vast majority of the UK’s 14,000 licensed medicines are in good supply, and they will continue working with industry partners to ensure continued medical product supply.